Medicare Enrollment Application- Reassignment of Medicare Benefits (CMS-855R)

The primary function of the CMS 855R enrollment application is to allow physicians and non-physician practitioners to reassign their Medicare benefits to a group practice and to gather information from the individual that tells us who he/she is, where he or she renders services, and information necessary to establish correct claims payment. The goal of evaluating and revising the CMS 855R enrollment application is to require the physician or non-physician practitioner to identify a primary group location where the physician or non-physician practitioner will render most of his or her services. This identification does not add any additional burden to the physicians or non-physician practitioners.

The latest form for Medicare Enrollment Application- Reassignment of Medicare Benefits (CMS-855R) expires 2023-01-31 and can be found here.

Establishing or adding a reassignment of benefits enrollment application

Federal Enterprise Architecture: Health - Health Care Services

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.