OMB control number
Medicare Enrollment Application for Institutional Providers (CMS-855A)
OMB 0938-0685 · HHS/CMS.
The primary function of the CMS-855A Medicare enrollment application is to gather information from a certified provider or certified supplier (hereafter occasionally and collectively referenced as “provider(s)”) that tells us who it is, whether it meets certain qualifications to be a health care provider, where it practices or renders services, the identity of its owners, and other information necessary to establish correct claims payments.
The latest form for Medicare Enrollment Application for Institutional Providers (CMS-855A) expires 2027-09-30 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Supporting Statement A |
Form CMS-855A Medicare Enrollment Application for Institutional Providers
CMS-855A - Supporting Statement.docx
Medicare Enrollment Application for Institutional Providers Medicare Enrollment Application for Institutional Providers
Federal Enterprise Architecture: Health - Health Care Services
| Form CMS-855A | Medicare Enrollment Application - Institutional Providers | Fillable Fileable Signable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.