On May 1, 2006, the Centers for Medicare & Medicaid (CMS) issued the revised CMS-855 Medicare enrollment applications.  Providers and suppliers should begin to use the new forms immediately.  They are available by clicking on the individual form links below or at the CMS website at: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp.

Please be aware that a significant change in the new forms is the requirement to report a National Provider Identifier (NPI) number.  Also, providers and suppliers not already using Electronic Funds Transfer (EFT) will be required to attach a CMS 588 form to authorize enrollment for EFT with the submission of any CMS 855 enrollment form.

A MLN Matters Article with details on the new 855 enrollment forms can be found at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0632.pdf

Information on the National Provider Identifier, including how to enroll, can be found at:
http://www.cms.hhs.gov/NationalProvIdentStand/

A CMS 588 (EFT Authorization) form can be downloaded from the CMS website at:
http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf

If you are submitting the CMS 855 form for new enrollment or a change to an existing enrollment record, it must be signed with an original signature and sent via U.S. Mail to:

Provider Enrollment Services
P.O. Box 890157
Camp Hill, PA 17089-0157

For more detailed information about filling out the necessary forms for enrollment or changes in the Medicare program, please access the Highmark Medicare Services Part B Reference Manual Chapter 3 - Provider Enrollment.

Questions on the new CMS 855 enrollment forms or the enrollment process can be directed to our Provider Enrollment helpline at 1-866-488-0549.

• Important Provider Enrollment Information
• Enrollment Forms
• Frequently Asked Questions About Enrollment
• National Provider Identifier