[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306235-105":53,"doc-detail-306235-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","medicare-enrollment-application-reassignment-of-medicare-benefits-cms-855r","MEDICARE ENROLLMENT APPLICATION - REASSIGNMENT OF MEDICARE BENEFITS - CMS-855R","","Medicare Enrollment Application CMS-855R addresses reassigning an individual practitioner’s right to bill Medicare and receive Medicare payments for Part B services, or terminating an existing reassignment. It defines who must complete and submit the form, including requirements that both the practitioner and eligible organization/group are enrolled (or concurrently enrolling). Instructions cover signing responsibilities, using PECOS or the paper application, documentation requests, privacy protections, and mailing the completed package to the designated Medicare Administrative Contractor.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medicare-enrollment-application-reassignment-of-medicare-benefits-cms-855r/306235/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medicare-enrollment-application-reassignment-of-medicare-benefits-cms-855r/306235.png","ImageObject",442,249,{"name":88,"@type":89},"Stanley","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who should complete and submit the CMS-855R Medicare reassignment application?","Question",{"text":109,"@type":110},"Complete CMS-855R when reassigning the right to bill Medicare and receive payments for Medicare Part B services, or when terminating an established reassignment. Both the individual practitioner and the eligible organization/group must be enrolled (or concurrently enrolling) for the reassignment to take effect.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is CMS-855R submitted and how do I check current reassignment status?",{"text":114,"@type":110},"Submit using the Internet-based PECOS system or by mailing the paper CMS-855R using the designated Medicare Administrative Contractor. To view current Medicare reassignment details, go to PECOS (https://pecos.cms.hhs.gov).",{"name":116,"@type":107,"acceptedAnswer":117},"What signing requirements apply for establishing versus terminating a reassignment?",{"text":118,"@type":110},"For a new reassignment, Section 6A must be signed by the individual practitioner and Section 6B by a delegated/authorized official of the organization/group (or the individual signs Section 6B when reassignment is to an individual). For termination, either Section 6A or Section 6B can be completed and signed, depending on who is terminating.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306235,1791332036,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":101,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},2336477405376,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","# MEDICARE ENROLLMENT APPLICATION\n\nREASSIGNMENT OF MEDICARE BENEFITS  \nCMS-855R  \nSEE PAGE 1 TO DETERMINE IF YOU ARE COMPLETING THE CORRECT APPLICATIONAND FOR INFORMATION ON WHFRE TO MAII THIS COMPLFTEDAPPLICATION  \nTO VIEW YOUR CURRENT MEDICARE REASSIGNMENTS GO TO:  \nHTTPS://PECOS.CMS.HHS.GOV  \n##           WHO SHOULD COMPLETE AND SUBMIT THIS APPLICATION          \n\nComplete this application if you are reassigning your right to bill the Medicare program and receive Medicarepayments for some or all of the services you render to Medicare beneficiaries,or are terminating a currentlyestablished reassignment of benefits.Reassigning your Medicare benefits allows an eligible organization/groupto submit claims and receive payment for Medicare Part B services that you have provided as a member of theorganization/group.Such an eligible organization/group may be an individual,a clinidgroup practice or otherhealth care organization.  \nBoth the individual practitioner and the eligible organization/group must be currently enrolled (or concurrentlyenrolling via submission of the CMS-855B for the eligible organization/group and the CMS-8551 for the individualpractitioner)in the Medicare program before the reassignment can take effect.Generally,this application iscompleted by the organization/group,signed by the Delegated/Authorized Official of the organization/group andthe individual practitioner,and submitted by the organization/group.When terminating a current reassignment,either the organization/group or the individual practitioner may submit this application with the appropriatesections completed and signed.  \nNOTE:A separate CMS-855R must be submitted for each organization/group where a reassignment is beingestablished or terminated.  \nThe individual or delegated/authorized official,by hisher signature,agrees to notify the Medicare AdministrativeContractor(MAC)of any future changes to this reassignment in accordance with 42 CFR §424.516(d)(2).  \nNOTE:An individual does not need to reassign their benefits to a corporation,limited liability company,  \nprofessional association,etc.,when helshe is the sole owner.See the CMS-8551 Application for Physicians and Non-Physician Practitioners for more information.  \nNOTE:Physician Assistants:This application should not be used to report employment arrangements.Employmentarrangements must be reported using the CMS-8551 application.  \nPhysicians and non-physician practitioners,other than physician assistants,can reassign Medicare benefits orterminate a reassignment of Medicare benefits after enrollment in the Medicare program or make a change intheir reassignment of Medicare benefit information using either:  \n·The Internet-based Provider Enrollment,Chain and Ownership System(PECOS),or  \n·The paper CMS-855R application.Be sure you are using the most current version.  \nFor additional information regarding the Medicare enrollment and reassignment process,including Internet-based  \nPECOS and to get the current version of the CMS-855R,go to http://www.cms.gov/MedicareProviderSupEnroll.  \n## INSTRUCTIONS FOR COMPLETING THIS APPLICATION\n\n·Type or print all information so that it is legible.Do not use pencil.Blue ink is preferred.  \n·Sign and date the certification statement(s)as appropriate.  \n·Enter all NPls in the applicable sections.  \n·Keep a copy of your completed Medicare reassignment package for your own records.  \n## ADDITIONAL INFORMATION\n\nWhen establishing a new reassignment,Section 6A must be signed by the individual practitioner and Section6B must be signed by a delegated or authorized official of the organization/group.If the reassignment is to anindividual,that person must sign Section 6B.When terminating a reassignment,either Section 6A or Section6B can be completed.Reassigned claims for services rendered by the individual will no longer be paid to theorganization/group after the effective date of the termination.  \nThe MAC may request additional documentation to support and validate inform","cbCaimuBvgHovpmT","https://ap.wps.com/l/cbCaimuBvgHovpmT","pdf",174609,"English","# Who Should Complete and Submit This Application\n# Instructions for Completing This Application\n# Additional Information\n# Where to Mail Your Application\n# Section 1: Basic Information\n# Section 2: Organization/Group Receiving the Reassigned Benefits","[{\"question\":\"Who should complete and submit the CMS-855R Medicare reassignment application?\",\"answer\":\"Complete CMS-855R when reassigning the right to bill Medicare and receive payments for Medicare Part B services, or when terminating an established reassignment. Both the individual practitioner and the eligible organization/group must be enrolled (or concurrently enrolling) for the reassignment to take effect.\"},{\"question\":\"How is CMS-855R submitted and how do I check current reassignment status?\",\"answer\":\"Submit using the Internet-based PECOS system or by mailing the paper CMS-855R using the designated Medicare Administrative Contractor. To view current Medicare reassignment details, go to PECOS (https://pecos.cms.hhs.gov).\"},{\"question\":\"What signing requirements apply for establishing versus terminating a reassignment?\",\"answer\":\"For a new reassignment, Section 6A must be signed by the individual practitioner and Section 6B by a delegated/authorized official of the organization/group (or the individual signs Section 6B when reassignment is to an individual). For termination, either Section 6A or Section 6B can be completed and signed, depending on who is terminating.\"}]","MEDICARE ENROLLMENT APPLICATION - REASSIGNMENT OF MEDICARE BENEFITS - CMS-855R | PDF",1789834544]