Credentialing

Published 12/19/2023

If you need to make a change to an existing Medicare record, you must use one of the forms listed below. Letters, faxes and postal change-of-address notifications are not acceptable. The specific form needed depends on your provider type:

  • CMS 855B: This application is used to enroll new health care organizations, such as group practices, or to make changes to an existing health care organization’s Medicare records
  • CMS 855I: This application is used to enroll new individual physicians or nonphysician practitioners, or to make changes to an existing individual physician or nonphysician practitioner’s Medicare records
  • CMS 855R: This application is used to reassign an individual physician’s or nonphysician practitioner’s Medicare benefits (reimbursement) to a group, or if the individual physician or nonphysician practitioner is making a change to an existing re-assignment agreement

Options

  • Download the appropriate CMS 855 form (JJ or JM) from the Enrollment Application Finder tool. Once downloaded, complete all appropriate fields, print, sign and mail the form to Palmetto GBA.
  • Complete and submit your application through PECOS website. Your application may be processed up to 50 percent faster than applications submitted on paper.

Last Reviewed: 12/19/2023

Having a Medicare Provider Transaction Access Number (PTAN) does not designate you as a participating provider within the Medicare program. A participating provider enters into a separate agreement (by completing CMS form 460) to accept assignment on all Medicare Part B claims. The participant agrees to accept the Medicare-approved amount as full payment for services and supplies covered under Part B. Fee schedules for participating providers are five percent higher than for non-participating providers.

Last Reviewed: 12/19/2023

Specialty codes are designated by CMS and can be found at data.cms.gov. This information is utilized nationally and is not MAC-specific. The data are updated twice a year, effective April 1 and October 1 of each year. The most current list can be found on the CMS website.

Last Reviewed: 12/19/2023


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