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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 · Find your provider type. Back to menu ... 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. 2026-05-01. Special Instructions. N/A. Downloads. CMS 855i; Get email ...
These forms and your required documents make up your enrollment application. Download them, fill out the PDFs electronically, then print them and fax them to us. It can take us up to 90 days to review your enrollment application.
The provider self-service application is available on the BCBSM provider portal. To access the portal, go to bcbsm.com and select the I am a Provider tab. Log in using your BCBSM portal ID.
Session Overview. Learn 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. Learn how to avoid common mistakes when submitting the 855-I&R. •.
Provider Enrollment and Change Process Required Document Checklist. Provider Classification. To avoid processing delays...gather these items before you get started. If applying for one or more networks, check the appropriate box on the signature document before submitting. Acupuncturist.
How to Submit Reassignment of Benefits Using the Revised CMS-855I Physicians and non-physician practitioners, including physician assistants, can enroll and report reassignments using either: • The Provider Enrollment, Chain and Ownership System (PECOS), or • The paper CMS-855I application PECOS Submissions
