CMS Issues a Revised CMS-855S Enrollment Application

DMEPOS suppliers may now use the revised CMS-855S enrollment application version (05/16). The newest version of the enrollment form has been updated to capture additional information pertinent for enrollment processing. Suppliers may use the 01/13 version of the CMS-855S through December 31, 2016, at which time any information received on the obsolete form will be returned to the supplier. To download a copy of the enrollment form, visit the CMS website at www.cms.gov/medicareprovidersupenroll.

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Telephone: 866-238-9652

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National Supplier Clearinghouse

Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

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