Medicaid Services (CMS) 855R Application - Reassignment of Medicare Benefits

Provider Types Affected
This MLN Matters Special Edition (SE) is intended for physicians, non-physician practitioners, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) and who choose to reassign their benefits or accept reassigned benefits of those claims.

Provider Action Needed
STOP - Impact to You
Physicians, non-physician practitioners, providers, and suppliers must use the revised CMS 855R (Reassignment of Benefits) application beginning June 1,2015.

CAUTION - What You Need to Know

The revised CMS 855R application will be available for use on the CMS.gov website as of December 29, 2014. MACs may accept both the current and revised versions of the CMS 855R through MAy 31, 2015, after which the revised CMS 855R application will be required to be submitted.
After May 31, 2015, MACs will return any newly submitted CMS 855R applications on the previous version (07/11) to the provider/supplier with a letter explaining that the CMS 855R has been updated and the current version of the CMS 855R (11/12) must be submitted.

GO-What You Need to Do
Make sure that your billing staffs are aware of these changes.

Background
Physician, non-physician practitioners, providers, and suppliers must use the revised CMS 855R application starting June 1, 2015. The revised CMS 855R has been stream lined and some sections have been re-ordered for clarity. The revised form includes an optional section for Physician Compare to help beneficiaries identify where their physicians are primarily practicing. This address must be one that is affiliated with the individual/organization where the benefits are being reassigned.