Any provider or supplier submitting updated enrollment data or new enrollment forms for Medicare purposes after June 1, 2008, must utilize the revised CMS 855 enrollment forms. These revised forms, which have a February 2008 effective date, are found at the CMS website using the links that were published when the forms were last revised in June 2006:

(Note: All links to CMS web site below open in new windows/tabs.)

855A (Institutional Providers):
www.cms.hhs.gov/cmsforms/downloads/cms855a.pdf
855B (Clinics/Group Practices):
www.cms.hhs.gov/CMSforms/downloads/cms855b.pdf
855I (Physicians/NPPs/PT/OT):
www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf
855R (Reassignment):
www.cms.hhs.gov/cmsforms/downloads/cms855r.pdf
855S (DMEPOS Suppliers):
www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf

Key changes in these revised forms were highlighted in a MLN Matters article available on the CMS website at: www.cms.hhs.gov/MLNMattersArticles/downloads/SE0810.pdf. Any provider or supplier that has not previously filed a CMS 855 form will need to complete the entire CMS 855 form, not just the sections required to be completed to report that enrollment data change. Additionally, the filing of a complete CMS 855 enrollment form triggers a requirement to file a new CMS 588 EFT agreement form. The CMS 588 form remains unchanged from the version which reflects a July 2007 effective date.