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The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued. For additional information regarding the Medicare enrollment process (including Internet-based PECOS) and to get the current version of the CMS-855I, go to CMS.gov/Medicare/Provider-Enrollment-and-Certification.
1 Μαΐ 2023 · CMS forms list; Beneficiary Notices Initiative (BNI) Health & drug plans. Back to menu section title h3. ... CMS 855I Dynamic List Information. Dynamic List Data. Form # CMS 855I. Form Title. Medicare Enrollment Application - Physicians and Non-Physician Practitioners. Revision Date. 2023-05-01. O.M.B. # 0938-1355. O.M.B. Expiration Date.
This video provides information for medical professionals completing the CMS from 855I to enroll in Medicare. 855I Formhttps://www.cms.gov/medicare/cms-forms...
1 Σεπ 2017 · Guidance for how to initially enroll, revalidate, and submit changes of information for individual providers, Cover all aspects of completing the CMS-855I & 855R with a walkthrough of both the paper and PECOS versions of the form and learn how to avoid common mistakes when submitting the 855-I&R.
Physicians and non-physician practitioners can apply for enrollment in the Medicare program or make a change in their enrollment information using either: • The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or • The paper enrollment application process (e.g., CMS 855I).
Medicare has merged the CMS-855R into the CMS-855I paper enrollment application. Physicians and non-physician practitioners can reassign your right to bill the Medicare program and receive Medicare payments for some or all the services you render to Medicare
The following forms can be used for initial enrollment, revalidations, changes in status, and voluntary termination: CMS-855A (PDF) for Institutional Providers. CMS-855B (PDF) for Clinics, Group Practices, and Certain Other Suppliers. CMS-855I (PDF) for Physicians and Non-Physician Practitioners.
