Credentialing

If you need to make a change to an existing Medicare record, you must use one of the forms listed below. Letters, faxes and postal change-of-address notifications are not acceptable. The specific form needed depends on your provider type:

• CMS 855B: This application is used to enroll new health care organizations, such as group practices, or to make changes to an existing health care organization’s Medicare records
• CMS 855I: This application is used to enroll new individual physicians or nonphysician practitioners, or to make changes to include new reassigments to an existing individual physician or nonphysician practitioner’s Medicare records

Options

• Download the appropriate CMS-855 form (JJ or JM) from the Enrollment Application Finder tool. Once downloaded, complete all appropriate fields, print, sign and mail the form to Palmetto GBA.
• Complete and submit your application through PECOS website. Your application may be processed up to 50 percent faster than applications submitted on paper.

Last Reviewed: 9/18/2024

Having a Medicare Provider Transaction Access Number (PTAN) does not designate you as a participating provider within the Medicare program. A participating provider enters into a separate agreement (by completing CMS form 460) to accept assignment on all Medicare Part B claims. The participant agrees to accept the Medicare-approved amount as full payment for services and supplies covered under Part B. Fee schedules for participating providers are five percent higher than for non-participating providers.

Last Reviewed: 9/18/2024

Specialty codes are designated by CMS and can be found at data.cms.gov. This information is utilized nationally and is not MAC-specific. The data are updated twice a year, effective April 1 and October 1 of each year. The most current list can be found on the CMS website.

Last Reviewed: 9/18/2024