Form Cms-8550 - Medicare Enrollment Application Page 3

ADVERTISEMENT

INSTRUCTIONS FOR COMPLETING THIS APPLICATION
All information on this form is required with the exception of those fields specifically marked as “optional.”
Any field marked as optional is not required to be completed nor does it need to be updated or reported as a
“change of information” as required in 42 C.F.R section 424.516. However, it is highly recommended that once
reported, these fields be kept up-to-date.
• Type or print all information so that it is legible. Do not use pencil. Blue ink is preferred.
• Complete all applicable sections and furnish your NPI.
• Keep a copy of your completed Medicare enrollment application for your records.
• Sign and date Section 8 of this application using blue ink.
ACRONYMS COMMONLY USED IN THIS APPLICATION
MAC: Medicare Administrative Contractor
NPI: National Provider Identifier
PECOS: Provider Enrollment Chain and Ownership System
WHERE TO MAIL YOUR APPLICATION
The MAC that services your state is responsible for processing your enrollment application. To locate the
mailing address for your designated MAC, go to https://
CMS-855O (01/17)
2

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Cms-855r - Medicare Enrollment Application - Reassignment Of Medicare Benefits Form Cms-855r - Medicare Enrollment Application - Reassignment Of Medicare Benefits Medical
Form Cms-855a - Medicare Enrollment Application - Institutional Providers Form Cms-855a - Medicare Enrollment Application - Institutional Providers Medical
Form Cms-855b - Medicare Enrollment Application - Clinics/group Practices And Certain Other Suppliers Form Cms-855b - Medicare Enrollment Application - Clinics/group Practices And Certain Other Suppliers Medical
Form Cms-855i - Medicare Enrollment Application - Physicians And Non-physician Practitioners Form Cms-855i - Medicare Enrollment Application - Physicians And Non-physician Practitioners Medical
Form Cms-855s - Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, And Supplies (dmepos) Suppliers Form Cms-855s - Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, And Supplies (dmepos) Suppliers Medical
Form Cms-20027 - Medicare Redetermination Request Form, Form Cms-20034 - Request For Medicare Hearing By An Administrative Law Judge Etc. Form Cms-20027 - Medicare Redetermination Request Form, Form Cms-20034 - Request For Medicare Hearing By An Administrative Law Judge Etc. Medical
Form Cms-671 - Ltc Facility Application For Medicare/medicaid Form Cms-671 - Ltc Facility Application For Medicare/medicaid Medical
Form Cms-10069 - Medicare Waiver Demonstration Application Form Cms-10069 - Medicare Waiver Demonstration Application Medical
Medicare Enrolment Application Form Medicare Enrolment Application Form Medical
Form Cms-838 Medicare Credit Balance Report Certification Page Form Cms-838 Medicare Credit Balance Report Certification Page Medical

Related Categories

Parent category: Medical
Download
Go
Page of 10