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1 maj 2023 · 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.
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.
You can enroll in Medicare by filling out these forms electronically using internet based-PECOS on the CMS website. Forms, whether paper or electronic, must be completed by all providers of services and suppliers of medical and other health services for enrollment in the Medicare program.
PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. New to PECOS? View our videos at the bottom of this page.
All physicians and non-physician practitioners must complete the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) application in order to initiate the enrollment process and, as applicable, wish to reassign their benefits under § 424.80.
Medicare enrollment application - Physicians and Non-Physician Practitioners (CMS-855I): This form should be completed by individual practitioners, including physicians and non-physician practitioners, who render Medicare Part B services to Medicare beneficiaries.
22 mar 2024 · Effective November 1, 2023, you must use the revised CMS-855I (Medicare Enrollment Application - Physicians and non-physician practitioners) to enroll or update your information.
