Home Office
Type of Change
Adding a Home Office
CMS 855A Sections Required
A CMS 855A is NOT required for the home office. However, each provider number in the chain must submit a change of information application to update the provider number with the home office information.
Section 1 (A.1,A.2,A.3)
Section 6 (for authorized representative, if no application is on file.)
Section 7 (Mark the box "Provider in chain for first time" and indicate the effective date.) Complete all applicable fields.
Section 15
Adding a Home Office is a 2-step process.
1.Complete the 855A for each provider impacted by the new home office. For example, an application needs to be submitted for each provider number with a Section 7.
2. Complete the New Home Office forms required to obtain a home office number and/or add a component to an existing home office. Call or email Stan Mcquatters at 803-382-6135 or email him at stan.mcquatters@palmettogba.com. For North Carolina Part A providers, contact Suzann Coy at 919-687-7161 or email her at suzann.coy@palmettogba.com.
Type of Change
Changing a Home Office
CMS 855A Sections Required
Each provider number in the chain must submit a change of information application (CMS 855A) to update the provider number with the home office information.
Section 1 (A.1,A.2,A.3)
Section 6 (for authorized representative, if no application is on file.)
Section 7 (Mark the change box and provide the effective date. Complete all applicable sections.
Section 15
Actions Taken By Intermediary
Providers will receive a confirmation letter notifying them that the home office has been added/changed.