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Medicare 855i and 855r s Form: What You Should Know
Use the following alternative enrollment forms for all CMS-855 forms: You must send these to Medicare and CMS on your own: Mental Health and Substance Abuse Services (MESAS) Enrollment Application Form All Forms from FCS/Novices Solutions/Solutions. All forms from Novices Solutions/FPC and all forms from Novices Solutions/Solutions. All Forms from FPC All forms from FPC/Solutions. Nov 6, 2023 — CMS-855S. If you are participating in the Medicare Access and CHIP Reauthorization Act of 2015, your enrollment in the MESAS Program may be terminated. If you are currently participating in MESAS but are no longer eligible for the medical services involved in participating in MESAS, contact the agency in your area where Medicare is contractually obligated to enroll you. Mental Health and Substance Abuse Services (MESAS) Re enrollment Enrollment Package for Health Care Providers. View these online and print before November 6, 2022, if you need to submit a paper enrollment. Complete all enrollment forms in a single package including these: Mental Health and Substance Abuse Services Enrollment Application Completed Form CMS855R Completed Form CMS-855I Completed Form CMS-855G Complete all forms in a single package (Form CMS-855) including these: Reassignment of Medicare Benefits Reassignment of Medicare Benefits Enrollment Application Form Complete All Forms from FPC Completed Form Health Plan for Individuals Under 65 Under Medicaid, Medicare, or Other Government-Sponsored Insurance. If you would like to complete only the enrollment documents for the Individuals under 65 who are not entitled to Medicare, complete this form instead. FPC Enrollment Packet (includes all forms from FPC. You may get around using only the enrollment packet if you complete all the Forms in one Application and Mail it to FPC and add in: CMS 845I If you are participating in the Medicare Access and CHIP Reauthorization Act of 2015, your enrollment in the MESAS Program may be terminated. If you are currently participating in MESAS but are no longer eligible for the medical services involved in participating in MESAS, contact the agency in your area where Medicare is contractually obligated to enroll you.
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