Medicare Enrollment Application Revised
By Ellen Terry


A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.

The CMS-855I form, revised in December 2018, is available for use now. After April 30, Novitas Solutions and the other Medicare administrative contractors will accept only this new version. You can identify the new form by the header on page two, which says: “Form Approved OMB No. 0938-1355 Expires: 12/21.”The Centers for Medicare & Medicaid Services (CMS) says many changes in the new application are minor, while the major ones “reduce provider burden.”

According to CMS, the new application:

  • Eliminates reporting for advanced diagnostic imaging, the Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number;
  • Expands instructions for individual and group affiliations to simplify reporting;
  • Makes it optional to list a contact person;
  • Adds electronic storage information for those who no longer keep paper records; and
  • Creates a more logical data flow.

Medicare requires you to revalidate your enrollment information every five years, after you receive a notice to revalidate from Novitas Solutions. As a member service, the Texas Medical Association will email you a reminder of your due date, with next steps, so you don’t miss any Medicare payments. If you revalidate using a paper CMS 855I after April 30, be sure to use the new application. The application changes already are incorporated online for those applying through PECOS.

Find the new application form and information about Medicare enrollment and revalidation on the Novitas Solutions website.

No HICNs Starting July 1

Beginning July 1, health insurance claim numbers (HICNs) will no longer appear on the Medicare Standard Paper Remit (SPR) — the paper remittance advice. CMS has instructed its payers to mask this patient identifier on the SPR so the Social Security number doesn’t show. Only the new Medicare Beneficiary identifier (MBI) will be visible.

Find more Medicare information on the TMA website.

Last Updated On

March 04, 2019

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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