Guidance on Completing the CMS-855A Enrollment Form
The Centers for Medicare & Medicaid Services (CMS) is issuing this article solely as
an educational guide to improve compliance with documentation requirements for the
Medicare Enrollment Application for Institutional Providers, Form CMS-855A (07/11).
This article presents a brief guide that you may use when completing the CMS-855A
application. Please note that use of this guide is not mandatory and does not
ensure Medicare enrollment.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: November 17, 2011
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.