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Printed Date: 9/22/2015
This Provider Address job aid was created to assist Part A and home health and hospice providers in completing and understanding the address sections of the CMS-855A enrollment application. In the charts below you will find the CMS-855A address with each Palmetto GBA department.
(Corresponding Fiscal Intermediary Shared system [FISS] Address Field Title)
(FISS: Other Address)
(FISS: Master Address)
CMS-855A: Section 4 B, Remittance Notices or Special Payments Mailing Address
(FISS: Remit Address, Check Address)
Other Mailing Addresses
On the CMS-855A Enrollment Application, the address sections are:
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Last Updated: 12/31/2020
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