Other Helpful Hints/Reminders
- Send in a cover letter explaining the change.
- Review the instructions on the CMS 855A, which are presented on the page prior to the section.
- The Authorized Representative or delegated official on file must sign ALL changes.
- Notify intermediary as soon as possible on address changes. Medicare does NOT forward mail.
- Notify intermediary as soon as possible on authorized representative changes.
- Report all changes within 90 days of the change.
- Remove from the booklet the pages used and only submit those pages.
- Do not fax the completed form. The form must be mailed and original signature is required.