To assist with the enrollment process for Medicare Part B we developed an on-line form tool. Based on your answers using the tool, we will provide a list of requirements and supporting documentation that are required.
We currently have modules available for Individual
Enrollments (Form 855I), Group Enrollments (Form 855B), and Re-assignment of
Medicare Benefits (855R).
For more detail on completion of the enrollment form, refer to the e-learning module at www.medicarenhic.com/providers/online/providerEnrollment/providerenrollment.html
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Interactive Tool |
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Launch |
Individual Enrollment (Form 855I) |
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In addition to the items included in the module, these items must also be included when enrolling or changing enrollment:
There are many advantages of billing claims electronically; for more information, see
the Electronic Data Interchange (EDI) section.
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Launch |
Group Enrollment (Form 855B) |
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In addition to the items included in the module, these items must also be included when enrolling or changing enrollment:
There are many advantages of billing claims electronically; for more information, see
the Electronic Data Interchange (EDI) section.
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Launch |
Re-assignment of Medicare
Benefits (Form 855R) |
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An individual who renders services and seeks to reassign his/her
benefits to an eligible entity must complete the CMS 855R Form for each
entity eligible to receive reassigned benefits. The person must be
enrolled in the Medicare program as an individual prior to reassigning
his/her benefits.
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