Medicare Enrollment Application for Institutional Providers (CMS-855A)

The primary function of the (CMS-855A,B,I) Medicare enrollment application is to gather information from a provider or supplier that tells us who it is, whether it meets certain qualifications to be a health care provider or supplier, where it practices or renders services, the identity of the owners of the enrolling entity, and other information necessary to establish correct claims payments.

The latest form for Medicare Enrollment Application for Institutional Providers (CMS-855A) expires 2021-12-31 and can be found here.