Answers to Frequently Asked Questions about Provider Enrollment
To enroll in Medicare as a provider or make changes to your existing Medicare information, you must complete the CMS-855A application. Per the Program Integrity Manual, Chapter 10, Section 7.1.1, you must submit a complete CMS-855A if you have not completed a full 855A application in the past few years.
Timeframes:
You can help us process your application by submitting complete, accurate information the first time. Please do the following when submitting your application:
- Check all applicable boxes and provide effective dates where needed
- Include a copy of IRS documentation as proof of Tax Identification Number (e.g., CP-575 or any legal document from the IRS showing the name and TIN)
- Sign and date all applications. Original signatures are required on each application
- Include a copy of all applicable state licenses
Note: Failure to provide all of the necessary information and/or documentation may cause your application to be returned to you for completion.
Call our Provider Enrollment staff at 1-866-734-9444 and ask for Provider Enrollment. Send your completed application, including original signatures, to the following address:
WPS Medicare
Medicare Provider Enrollment – Part A
PO Box 1604
Omaha, NE 68101
CMS 855A Application Completion Questions
Page Last Updated: Friday, 06-Nov-2009 14:11:58 CST
