Situation 1: Individual (practicing under Social Security Number), sole proprietor (practicing under Employer Identification Number), sole owner of a PC, PLLC, LLC, etc.

Note: A sole owner implies that an organization is identified under an individual’s ownership. A sole owner is not the same as a sole proprietor; a sole proprietor is not incorporated and would not enroll as PC, PLLC, etc.

Resolution Completion of the CMS-855I Medicare enrollment application, National Provider Identifier (NPI), and electronic funds transfer (EFT) agreement are required. For solely owned PC, PLLC, LLC, etc, an NPI is required for both individual provider and business.

Situation 2: Group/organization is enrolling for the first time.

Resolution: Complete the CMS-855B and CMS-855R Medicare enrollment applications for each member.

Note: If members are not currently active in Medicare Part B, they must also complete the CMS-855I Medicare enrollment application.

Situation 3: Change of information, i.e., name, specialty, practice location, billing agency address, pay to address, mailing address, telephone number, and/or deactivate Medicare billing number(s) for:

• Individual: Individual who has formed a professional corporation, professional association, limited liability company, etc., of which you are the sole owner
• Group/organization: EFT is now required for all changes of information

Note: If you are changing your “pay to” address, and have never completed the CMS-855 Medicare enrollment application, you are required to do so at this time.

Resolution: If you are changing your “pay to” address, and have never completed the CMS-855 Medicare enrollment application, you are required to do so at this time.

• Complete all sections of the CMS-855I Medicare enrollment application that correspond to the changes being requested; sign and date #15
• Complete all sections of the CMS-855B Medicare enrollment application that correspond to the changes being requested; sign and date #15
• Completion of the CMS-588 EFT agreement is required for all changes of information

Note: The EFT is required.

Situation 4: Changing tax ID

Resolution: Complete the CMS-855B Medicare enrollment application; if sole owner, complete CMS-855I Medicare enrollment application.

Situation 5: Changing ownership

Resolution: Complete the CMS-855B Medicare enrollment application.

Situation 6: Medicare active provider joining an active established Medicare group

Resolution: Complete the CMS-855R Medicare enrollment application.

Situation 7: Group updating status of membership

Resolution: Complete the CMS-855R Medicare enrollment application