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Video instructions and help with filling out and completing CMS-855A Form
Music hello and welcome to our video about completing the CMS 855 our application for physician or non-physician practitioners to reassign Medicare benefits to an organization or group before we begin here are some tips to identify the difference between the CMS 855 Part B Medicare enrollment applications CMS 855 I for individual physician or non-physician practitioners CMS 855 B for business clinics or group practices in certain other suppliers CMS 855 R for reassignment reassignment of Medicare benefits and CMS 855 o for ordering certifying or prescribing enrollment for eligible ordering certifying and prescribing physicians and other eligible professionals during this video we will go over completing the CMS 855 R for reassignment of Medicare benefits application for a physician or non physician practitioner to reassign benefits to an organization or group a physician assistant will not complete this application the CMS 855 I will need to be completed to show the physician assistance employment arrangement with the organization or group in addition to completing a CMS 855 our application if the physician or non physician practitioner is new to the Medicare administrative contractor for the state the services are rendered they will also need to complete a CMS 855 I application each required section of the CMS 855 our application will be addressed and we'll go over some helpful tips in certain sections to prevent delay in your application process let's begin completing the application once you have selected your line of business and state on ngsmedicare.com accept the attestation click on the enrollment mega tab then select enrollment forms finally you will click the CMS 855 our form who should complete this application all physician and non-physician practitioners other than physician assistants that will be reassigning medicare benefits a separate CMS 855 are must be submitted for each organization or group tax ID where a reassignment of benefit is being established continue reading the instructions on page 1 for information about provider enrollment chain and ownership system or Pecos Pecos will allow electronic submission of the 855 our application instead of filling out the paper application form at the bottom of the page are instructions for completing the application as well as how to locate the fee for service contractors mailing address this paper application can be downloaded and completed online once complete print the application and have the individual physician or non physician practitioner and the authorized or delegated official of the group sign and date section 6 certification statement and mail the application to the appropriate fee-for-service contractor section 1 basic information starting at the top of page 2 under reason for application select you are enrolling or are currently enrolled in Medicare and will be reassigning your benefits indicate the effective date then complete all sections as instructed section 2 organization or group receiving the signe benefits all fields must be complete indicate the organization or groups information the legal business name and tax identification number must coincide with the information on the.