Medicare Enrollment Application Information: MBC

CMS received approval for a new Medicare Enrollment Application for physicians and non-physician practitioners (CMS-855I dated 12/2018). Many changes are minor; the major ones reduce provider burden:

  • Eliminated reporting for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number
  • Expanded instructions for individual and group affiliations to simplify reporting
  • Made it optional to list a contact person
  • Added electronic storage information for those who no longer keep paper records
  • Created a more logical data flow

You may begin using the new application immediately. Through April 30, Administrative Contractors will accept applications dated 7/2011, but after that, you have to use the new version.

Who is affected? (Medicare Provider/Supplier Enrollment Applications)

All physicians and other qualified healthcare professionals (as defined in section 1848(k)(3)(B) of the Social Security Act) must use the CMS-855I (or PECOS) to enroll in the program and receive a billing number.

The Medicare enrollment application (CMS-855 or Internet-based Provider Enrollment, Chain and Ownership System (PECOS)) is an Office of Management and Budget approved form and is available in PDF fillable format. This format allows a user to complete an application using Adobe Acrobat and save this information on their personal computer or download the application. To access the applications, please refer to the CMS Forms List link below.

Submitting an Application:

Medicare enrollment application forms are fillable on your computer. This means that you can fill out the information required by typing into the open fields while the form is displayed on your computer monitor. Filling out the forms this way before printing, signing and mailing means more easily-readable information – which means fewer mistakes, questions, and delays when your application is processed. Be sure to make a copy of the signed form for your records before mailing.

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