When a client needed to add an individual provider to an existing group, we turned to CMS Form 855R. Here is a full walkthrough of how we completed that process.
What Is CMS Form 855R?
CMS Form 855R is the Medicare Enrollment Application used to reassign benefits. When an individual provider wants to reassign their Medicare benefits to a group practice (or be added to one), this is the form you use.
Step-by-Step: Filling Out the 855R
Section 1 – Reason for Submission
Mark "Change of Information" if the provider is already enrolled in Medicare. If this is a new enrollment, mark "Initial Enrollment."
Section 2 – Individual Information
Enter the provider's personal NPI, name, date of birth, and Social Security Number. Make sure the name matches exactly what is on file with NPPES.
Section 3 – Reassignment Information
This is where you enter the group's billing NPI. You will also need the group's Medicare PTAN (Provider Transaction Access Number) if available.
Section 4 – Contact Person
Include a contact person at the group practice — typically the billing department or office manager.
Section 5 – Signatures
Both the individual provider AND an authorized official of the group must sign. This is a common sticking point — make sure both parties are available.
Mailing the Form
Once complete, mail to the appropriate Medicare Administrative Contractor (MAC) for your jurisdiction.
- Regular mail: Expect 14–35 business days for processing
- Overnight mail: Expect 7–10 business days
The Fastest Method: PECOS
If you want the fastest turnaround, skip the paper form and complete the process via PECOS (Provider Enrollment, Chain and Ownership System) at pecos.cms.hhs.gov. Electronic submissions typically process in approximately 1 week.
Tips From Our Experience
- 1. Double-check NPI numbers before submitting — a single digit error means starting over
- 2. Use PECOS whenever possible for speed
- 3. Follow up after 10 business days if you have not received a confirmation number
- 4. Keep a copy of everything you submit for your records
Credentialing delays cost practices real money. If you are adding a new provider and want to make sure the process goes smoothly, reach out to our team at MedLink Services.