CMS-855S - Medicare Enrollment Application - Change Request

CMS-855S - Non-Sub Change Request.docx

Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

CMS-855S - Medicare Enrollment Application - Change Request

OMB: 0938-1056

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Non-Substantive Change Request:



OMB Control number 0939-1056

CMS-855S – Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)



The following changes were submitted to OMB and approved on October 21, 2021. However, the incorrect version of the document was uploaded with the original submission. This non-substantive change request seeks to correct that oversight and place the correct version of the CMS-855S form on file.

Changes to the Form CMS-855S

2021

(old version)

January 2022 (new version)

Type of Change

Reason for Change

Burden Change

Included only Section 4. B.

Added: Section 4.B.2.


2. MEDICAL RECORD CORRESPONDENCE ADDRESS

Revision

This address was added due to an overwhelming request from the provider/supplier community via the Provider Compliance Group (CMS/PCG) to add a separate field to collect this specific information. MACs requested


No









File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJAMAA HILL
File Modified0000-00-00
File Created2022-01-12

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