5 Steps To Complete Form 855r For Medicare Enrollment

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Enrolling in Medicare can be a daunting task, especially when it comes to filling out the necessary forms. Form 855R, also known as the Medicare Enrollment Application for Reassignment of Medicare Benefits, is a crucial document that requires attention to detail and a thorough understanding of the Medicare enrollment process. In this article, we will break down the 5 steps to complete Form 855R for Medicare enrollment, making it easier for you to navigate the process.

Step 1: Gather Required Information and Documents

Before starting to fill out Form 855R, it's essential to gather all the required information and documents. This includes:

• Your National Provider Identifier (NPI)
• Your Taxpayer Identification Number (TIN)
• Your Medicare Provider Transaction Access Number (PTAN)
• Your business address and phone number
• The name and title of the authorized official signing the application
• The reassignment information, including the name and NPI of the provider or supplier to whom you are reassigning your Medicare benefits

Step 2: Understand the Purpose of Form 855R

Form 855R is used to reassign your Medicare benefits to another provider or supplier. This is typically done when a provider wants to reassign their Medicare benefits to a new entity, such as a hospital or a medical group. It's essential to understand the purpose of the form and ensure that you are filling it out correctly.

Types of Reassignments

There are two types of reassignments:

• Reassignment of Medicare Benefits: This type of reassignment allows you to reassign your Medicare benefits to another provider or supplier.
• Change of Ownership: This type of reassignment is used when there is a change in ownership of a Medicare-enrolled provider or supplier.

Section 1: Reassignment Information

In this section, you will need to provide the reassignment information, including the name and NPI of the provider or supplier to whom you are reassigning your Medicare benefits.

• Reassigning Provider/Supplier Information: Provide the name and NPI of the provider or supplier to whom you are reassigning your Medicare benefits.
• Effective Date of Reassignment: Enter the date when the reassignment will take effect.

Step 3: Complete Section 2: Provider/Supplier Information

In this section, you will need to provide information about the provider or supplier reassigning their Medicare benefits.

• Provider/Supplier Name: Enter the name of the provider or supplier reassigning their Medicare benefits.
• Provider/Supplier NPI: Enter the NPI of the provider or supplier reassigning their Medicare benefits.
• Provider/Supplier Address: Enter the address of the provider or supplier reassigning their Medicare benefits.

Section 2A: Additional Provider/Supplier Information

If you are reassigning your Medicare benefits to a new entity, you will need to complete Section 2A.

• New Entity Name: Enter the name of the new entity to whom you are reassigning your Medicare benefits.
• New Entity NPI: Enter the NPI of the new entity to whom you are reassigning your Medicare benefits.

Step 4: Complete Section 3: Authorized Official Information

In this section, you will need to provide information about the authorized official signing the application.

• Authorized Official Name: Enter the name of the authorized official signing the application.
• Authorized Official Title: Enter the title of the authorized official signing the application.
• Authorized Official Signature: The authorized official must sign the application.

Step 5: Review and Submit the Application

Once you have completed all the sections, review the application carefully to ensure that all the information is accurate and complete. Make any necessary corrections before submitting the application.

• Submit the Application: Submit the completed application to the Medicare Administrative Contractor (MAC) for processing.

By following these 5 steps, you can ensure that your Form 855R is completed accurately and submitted successfully. Remember to review the application carefully before submitting it to avoid any delays in the Medicare enrollment process.

We hope this article has provided you with a comprehensive guide to completing Form 855R for Medicare enrollment. If you have any further questions or concerns, please don't hesitate to comment below.