Medicare provider enrollment is the process, started by an application filed with a Medicare contractor, through which a provider or supplier receives Medicare billing privileges or eligibility to order or certify. The rules are in 42 CFR Part 424, Subpart P, and the forms are the CMS-855 series. Integral Healthcare Solutions (IHS) builds the working packet for new practices and facilities, organizations changing owners, locations or signers, and organizations preparing for revalidation. IHS drafts; your authorized official reviews, signs and files.
Last updated: November 2026
What is Medicare provider enrollment, and which CMS-855 form applies?
Enrollment is the process Medicare uses to establish eligibility to submit claims for covered items and services, or to order or certify them (42 CFR 424.502). Providers and suppliers submit enrollment information on the applicable application, and CMS enrolls them once they successfully complete the process, including a State survey and certification or accreditation process, if applicable (424.510(a)(1)). Text read: the current eCFR text of 42 CFR Part 424, Subpart P (title last amended October 8, 2026, including the December 2, 2025 amendments at 90 FR 55617), and CMS pages and forms, all opened November 5, 2026.
| Form | Who files it, per the form | Points that catch applicants |
|---|---|---|
| CMS-855A | Institutional providers such as hospitals, skilled nursing facilities, home health agencies and hospices | Type 2 NPI required. If your type is not listed, contact your Medicare Administrative Contractor (MAC) first. |
| CMS-855B | Clinics, group practices and other suppliers | Type 2 NPI required. A sole owner adding an authorized or delegated official uses this form, not the CMS-855I. |
| CMS-855I | Physicians and non-physician practitioners | Reassignments go here or on the CMS-855B; the CMS-855R is discontinued. Practitioner and organization must both be enrolled, or enrolling together. |
| CMS-855O | Physicians and eligible professionals enrolling only to order or certify | They do not send claims to a MAC. |
| CMS-855S | DMEPOS suppliers | Outside this page. |
CMS offers online PECOS enrollment or paper forms (signed by hand).
Who signs, and who can sign later?
The certification statement must be signed by an individual with authority to bind the provider or supplier legally and financially who also has an ownership or control interest in it, such as a general partner or chief executive officer, or who holds a position of similar status and authority (424.510(d)(3)). An individual practitioner signs personally, a sole proprietor as sole proprietor, and an organization through an authorized official, defined in 424.502 as an appointed official to whom the organization has granted legal authority to enroll it, make changes and updates, and commit it to fully abide by Medicare statutes, regulations and program instructions.
An authorized official must sign the initial application and every revalidation. A delegated official may sign updates reported outside those, and must have an ownership or control interest or be a W-2 managing employee. Until a delegation exists, the only acceptable signature on an update or change is that of the authorized official on file; individual practitioners and sole proprietors cannot delegate signature authority.
Who needs it and what triggers it?
The CMS-855A and CMS-855B list these triggers: first enrollment with a MAC under a tax identification number, a new tax identification number, a location in another MAC's jurisdiction, revalidation, reactivation, changes and a change of ownership (on the CMS-855A, and on the CMS-855B for certified Part B providers).
- Revalidation. Providers and suppliers other than DMEPOS suppliers and ambulance service providers (which follow their own rules) resubmit and recertify every 5 years; CMS contacts you, and the application is due within 60 calendar days of the notice (424.515). The forms say not to submit before the MAC contacts you.
- Changes. Reports carry 30-day and 90-day clocks by provider type in 424.516. CMS may revoke for failure to meet the reporting requirements, weighing whether and how late the data was reported, how material it was, and other relevant information (424.535(a)(9)).
What makes CMS reject or deny an application, or deactivate billing privileges?
Section 424.525 lets CMS reject an application when complete information is not furnished within 30 calendar days of the contractor's request.
Deactivation stops billing. Grounds include no Medicare claims for 6 consecutive calendar months, not reporting a change within the required time, a practice location that is non-operational or otherwise invalid, and not furnishing complete and accurate information and all supporting documentation within 90 calendar days of receiving CMS's notice to submit an application or to resubmit and certify. Denial grounds include false or misleading information submitted on the application to gain enrollment, a CMS determination, on on-site review or other reliable evidence, that you are not operational, or an excluded or debarred applicant, owner, officer, director, managing employee, authorized or delegated official, medical director or other listed personnel. CMS may bar reapplication for up to 10 years when a denial rests on false or misleading information on or with, or information omitted from, the application to gain enrollment.
How IHS helps
Thomas G. Goddard, JD, PhD, IHS founder and former URAC Chief Operating Officer and General Counsel, leads the work. Enrollment preparation sits in IHS's Compliance Services practice line.
What IHS drafts
- A form and signer map with a delegation record.
- Owner and managing-employee disclosure worksheets, including the indirect-ownership arithmetic.
- A deadline log for the 30-, 60-, 90- and 120-day clocks.
- An exclusion-check worksheet.
What you supply
Every source document, the ownership and management facts, the choice of authorized official, the signature, the filing and every contractor reply.
The real limit
IHS does not sign, file, contact the Medicare contractor or CMS, check status, or represent you in a rejection, denial or revocation.
What to have ready
- Your provider or supplier type and the form your contractor says applies (424.525(a)(1)(x)).
- A Type 2 NPI for an organization (CMS-855A, CMS-855B), with names and numbers matching your NPI record exactly (CMS-855A, CMS-855B, CMS-855I, CMS-855O).
- Proof of legal business name, practice location, SSN where applicable, tax identification number, NPI if issued, and owners (424.510(d)(2)(ii)).
- Every owner: any partnership interest or 5 percent or more direct or indirect ownership, indirect interests found by multiplying percentages (424.502).
- Officers, directors and managing employees (424.502), plus owners, employees and contractors, checked against exclusion and debarment lists (424.530(a)(2); 424.516(a)(3)).
- All applicable Federal and State licenses and certifications, eligibility documents, and other documents needed to verify the application, including ownership or management (424.510(d)(2)(iii)).
- The named authorized official, with ownership or control interest or similar status and authority, and any delegation record (424.510(d)(3)).
- Evidence you are operational, meaning a qualified physical practice location open to the public for health care related services, ready to submit valid Medicare claims, properly staffed, equipped and stocked as applicable (424.510(d)(6); 424.502).
- The CMS-588 for electronic funds transfer (424.510(d)(2)(iv), (e)).
- A fee decision from the CMS fee matrix (424.514).
The introductory call is the first step.
How it compares
- Independent diagnostic testing facilities must also meet the standards in 42 CFR 410.33; see the IHS page on IDTF Medicare enrollment readiness.
- Providers that part 488 requires to be surveyed or certified by the State, and that must sign a part 489 provider agreement, meet those requirements too (424.510(d)(5)); revalidation needs no new certification or provider agreement, but they must keep meeting those requirements (424.515(b)).
- This page covers Medicare only; health center credentialing and Medicaid enrollment strategy is a separate IHS page.
What it costs
Under 42 CFR 424.514, institutional providers, which include CMS-855B suppliers other than physician and non-physician practitioner organizations (424.502), submit the fee, a hardship exception request, or both with an initial application, a new practice location application or a revalidation. The fee is adjusted yearly and is nonrefundable except in listed cases. CMS's fee matrix shows no fee for physicians, non-physician practitioners and clinic or group practices, and a fee for hospitals, home health agencies, hospices and skilled nursing facilities on initial enrollment, revalidation and an added location. Verify current fees with CMS. IHS scopes each engagement after a free introductory call.
What this is not
- IHS is a consulting firm, not a law firm; appeals go to your counsel.
- The contractor and CMS decide approval; IHS promises none.
Frequently asked questions
Which CMS-855 form do we file?
The CMS-855A for institutional providers such as hospitals, skilled nursing facilities, home health agencies and hospices; the CMS-855B for clinics, group practices and other suppliers; the CMS-855I for physicians and non-physician practitioners; the CMS-855O for practitioners who only order or certify. The wrong form is a rejection situation (42 CFR 424.525(a)(1)(x)).
Who has to sign the enrollment application?
Under 42 CFR 424.510(d)(3), an individual with authority to bind the provider or supplier legally and financially who also has an ownership or control interest in it, such as a general partner, chairman of the board, chief financial officer, chief executive officer or president, or who holds a position of similar status and authority. An organization signs through an authorized official.
Can our practice administrator or a consultant sign?
Only an authorized official may sign an organization's initial or revalidation application. A delegated official may sign updates, and must have an ownership or control interest in the organization or be a W-2 managing employee. A practice administrator or consultant without an ownership or control interest or W-2 managing-employee status cannot be a delegated official.
What gets an application rejected, and can we appeal?
Under 42 CFR 424.525(a), CMS may reject an application when complete information is not furnished within 30 calendar days of the contractor's request for missing information. That covers an unsigned or undated application, a copied or stamped signature, a signature dated more than 120 days before receipt, an unauthorized signer and the wrong CMS-855 form, among other listed situations. CMS may also reject when supporting documents are not furnished within 30 calendar days of submitting, or when a prospective institutional applicant files neither the correct fee nor a hardship request with the application. Rejected applications have no appeal rights; you submit a new one.
How soon must we report a change?
Physicians, non-physician practitioners and their organizations must report a change of ownership, an adverse legal action, or a change, addition or deletion of a practice location within 30 days and other changes within 90 (42 CFR 424.516(d)). Other providers and suppliers report a change of ownership or control (including changes in authorized or delegated officials), an adverse legal action, or a change, addition or deletion of a practice location within 30 days, and other changes within 90, with 30 days for an air ambulance license or certification suspension or revocation (paragraph (e)). IDTFs, DMEPOS suppliers and MDPP suppliers report under 42 CFR 410.33(g)(2), 424.57(c)(2) and 424.205(c)(5).
Does a Medicare enrollment application cost anything?
Only for some types. Institutional providers, which include CMS-855B suppliers other than physician and non-physician practitioner organizations (42 CFR 424.502), submit a fee, a hardship exception request, or both with an initial, new-location or revalidation application under 42 CFR 424.514; CMS's fee matrix shows no fee for physicians, non-physician practitioners and clinic or group practices.
Can CMS visit our site before approving enrollment?
Paragraph (d)(8) of 42 CFR 424.510 says CMS reserves the right to perform on-site inspections when deemed necessary. Paragraph (d)(6) requires the provider or supplier to be operational before billing privileges are granted, and under 424.518 the contractor conducts an on-site visit for moderate-risk types such as IDTFs and high-risk types such as newly enrolling home health agencies, hospices and skilled nursing facilities.
Are we still responsible if a consultant prepares the application?
Yes. Under 42 CFR 424.510(d)(10), providers and suppliers are legally responsible for the accuracy, completeness and truthfulness of everything they provide on or with their applications, regardless of whether another party completed the application. The signature also attests that the information is accurate (424.510(d)(3)). CMS may deny enrollment for false or misleading information submitted to gain enrollment (424.530(a)(4)) and may revoke for false or misleading information certified as true to be enrolled or stay enrolled (424.535(a)(4)).