Form CMS-855A: Filing, Screening, and Revalidation Steps

Form CMS-855A is the Medicare enrollment application for institutional providers — hospitals, skilled nursing facilities, home health agencies, hospices, and similar organizations that bill under Medicare Part A. You file it through the Provider Enrollment, Chain, and Ownership System (PECOS) at pecos.cms.hhs.gov or by mailing a paper version to your assigned Medicare Administrative Contractor (MAC), pay a $750 application fee, and then move through a multi-stage review that typically includes a state survey before Medicare issues your billing number.

Which Providers File the 855A

The 855A is only for institutional providers furnishing services under Medicare Part A or certain designated Part B services. Individual practitioners file the 855I; suppliers file the 855B. Filing the wrong form gets the application returned right away, so confirm your provider type first.

Institutional provider types that use Form CMS-855A include:

Hospitals — general acute care, critical access, rural emergency, and federally owned facilities
Skilled nursing facilities, including those with distinct-part units
Home health agencies
Hospice programs
End-stage renal disease facilities
Rural health clinics and federally qualified health centers
Comprehensive outpatient rehabilitation facilities
Religious nonmedical health care institutions
Organ procurement organizations

Each of these must submit the applicable enrollment information and complete any required state survey and certification before CMS finalizes enrollment.¹ The 855A is also built to capture the layered corporate structures typical of institutional providers: multiple practice locations under one tax ID, tiered ownership, and sub-units that simpler forms cannot handle.

What to Gather Before You Open the Application

The 855A is long and detail-heavy. Assembling everything before you start prevents the back-and-forth that triggers development requests and drags out the review.

Organizational Identifiers

Your Legal Business Name and Employer Identification Number must appear on the form exactly as they appear in IRS records. A minor discrepancy — an ampersand versus the word “and,” a missing comma in an LLC name — can stall the application. You also need your National Provider Identifier, the ten-digit number assigned through the National Plan and Provider Enumeration System.² If your organization does not yet have an NPI, apply at nppes.cms.hhs.gov before starting the 855A.

Ownership and Management Disclosures

Every individual or entity with a five percent or greater direct or indirect ownership interest must be disclosed, along with all managing employees, officers, directors, and general partners. Federal screening checks these individuals for prior healthcare fraud convictions, exclusions from federal programs, and outstanding Medicare debt. False or incomplete ownership data can lead to denial or civil monetary penalties.

Skilled nursing facilities have expanded disclosures under Section 1124(c) of the Social Security Act. SNFs must identify each member of the governing body, every officer, director, partner, trustee, or managing employee, and each “additional disclosable party” — any person or entity exercising operational, financial, or managerial control, leasing real property to the facility, or providing management, consulting, or financial services.³ Corporations disclose officers, directors, and shareholders with five percent or greater ownership. LLCs report all members and managers regardless of ownership percentage.

Supporting Documents

IRS verification — a CP-575, 147C, or other IRS document confirming the exact Legal Business Name and EIN. The MAC compares this against the application, so the match must be exact.⁴
Current state-issued operating licenses for every practice location, plus accreditation certificates from a CMS-approved accrediting organization if applicable.
Evidence of 501(c)(3) designation if the organization claims tax-exempt status.
Form CMS-588, the Electronic Funds Transfer Authorization, directing Medicare payments into a business bank account whose name matches the Legal Business Name on the 855A. The MAC will not finalize enrollment without it.⁵

Practice Locations and Authorized Official

List every physical location where your organization furnishes services or stores medical records. Multiple sites under one tax ID each get their own disclosure. The form requires at least one Authorized Official — a person such as the CEO, CFO, general partner, or board chairman granted authority to enroll the organization in Medicare and bind it to program requirements.⁶ You can designate more than one Authorized Official, and additional individuals can be named as Delegated Officials to sign future updates after the initial application is approved.

How to Submit the Form

You have two options: PECOS online, or a paper application mailed to your MAC. CMS recommends PECOS, and the processing-time gap makes a strong case for it.

Filing Through PECOS

Go to pecos.cms.hhs.gov. You need an Identity and Access Management System (I&A) user ID and password to log in. Authorized officials, delegated officials, and individuals working on behalf of the provider can each register.⁷ PECOS validates certain fields in real time, lets you see the same enrollment data the MAC sees, and folds the application fee payment into the submission workflow. One MAC reports roughly 15 calendar days to process initial and change-of-information applications submitted through PECOS, versus about 30 days for paper.⁸

Filing on Paper

Download the form from the CMS website and mail the completed application with all supporting documents to your assigned MAC. To identify your MAC, use the CMS lookup at cms.gov/mac-info.⁹ Paper takes longer — roughly 60 calendar days for MAC processing alone — because the contractor has to key the data in before review begins.

Paying the Application Fee

The 2026 Medicare enrollment application fee is $750.¹⁰ Institutional providers pay it when initially enrolling, revalidating, or adding a new practice location.¹¹ The MAC will not begin processing until it confirms payment. PECOS builds the payment into submission; for paper, pay through the CMS fee portal before mailing.

Providers in a Presidentially declared disaster area can request a hardship exception by including a letter with the application that describes the hardship. CMS has 60 days to decide, and the MAC pauses processing until it does.¹² If the exception is denied, you have 30 days from notification to submit the fee or the application itself is denied.

How Your Provider Type Affects Screening

CMS assigns every provider type a categorical risk level that dictates how intensively the MAC screens the application. Knowing yours sets expectations for the review.

Limited risk covers hospitals (including critical access and rural emergency), ESRD facilities, FQHCs, RHCs, organ procurement organizations, and religious nonmedical health care institutions. The MAC verifies federal and state compliance, checks licenses, and runs database screenings before and after enrollment.¹³
Moderate risk covers CORFs and community mental health centers, among others. The MAC does all limited-level checks plus an on-site visit.
High risk covers newly enrolling home health agencies, SNFs, and hospices. The MAC does moderate-level screening plus fingerprint-based criminal background checks for anyone with a five percent or greater ownership interest.

Risk levels can be elevated. A prior CMS payment suspension, or an OIG exclusion of someone with an ownership stake, can push a provider to high risk regardless of its usual category. SNFs, HHAs, and hospices going through a change of ownership are also treated as high risk for that transaction.

What Happens After You Submit

Enrollment moves between your MAC, the state survey agency, and possibly a national site-visit contractor.

MAC Review

The MAC checks completeness, verifies your identifying information against IRS and NPI databases, screens ownership disclosures, and runs background checks appropriate to your risk level. If something is missing or unclear, the MAC issues a development request. You generally have 30 days to respond; missing that window can result in the application being returned or denied.¹⁴

State Survey and Certification

After MAC review, the application goes to the state survey agency, which verifies that the facility meets federal, state, and local requirements — usually with an on-site survey. The state then sends its determination back to the MAC.¹⁵ Institutions accredited by a CMS-approved accrediting organization can bypass the state survey, though they still notify the state agency of the accreditation.

Site Visit and Final Decision

For moderate- and high-risk providers, the MAC may order an unannounced site visit by the National Site Visit Contractor to confirm the facility is operational. From initial MAC review through state survey, site visit, and final decision, the process can span several months when all steps combine.¹⁶ Successful applicants receive an approval letter with a Medicare billing number and an effective date that determines when you can start billing.

Why Applications Get Denied

Most denial grounds are avoidable with careful preparation:

Noncompliance with enrollment requirements, including failure to submit a corrective action plan when required
False or misleading information anywhere on the application, whether intentional or careless
The facility is not operational or not ready to furnish Medicare-covered services when the site visit occurs
Outstanding Medicare debt owed by the enrolling provider, or by a prior owner who left within a year before the provider’s enrollment was terminated or revoked
Unpaid application fee after a denied hardship exception, if the $750 is not submitted within 30 days of notification
A CMS-imposed geographic moratorium on new enrollments for the provider type in the applicant’s area

These grounds sit in the federal enrollment regulations.¹⁷ Home health agencies face one additional trigger: they must demonstrate sufficient initial reserve operating funds on request, or the application can be denied.

Keeping Your Enrollment Current

Approval is not the end. You are responsible for keeping your enrollment data current, and reporting deadlines depend on what changed.

Within 30 days: a change of ownership, any adverse legal action (such as a felony conviction, license revocation, or exclusion from a federal program), or a change in practice location.¹⁸
Within 90 days: all other changes, including new bank account information, a change in Authorized Official, or updates to ownership percentages that do not amount to a formal change of ownership.

Missing the 30-day window for reportable changes like ownership transfers or practice location moves can result in revocation of your Medicare billing privileges.¹⁹

Change of Ownership

A CHOW happens when a Medicare provider is purchased or leased by another organization. The transaction transfers the existing Medicare identification number and provider agreement, including any outstanding Medicare debt, to the new owner. Both parties complete portions of the 855A: the seller fills out identifying sections and the certification statement, while the new owner completes the entire application. A copy of the bill of sale goes with the submission, and the final sales agreement follows once the sale closes.⁶

Not every ownership change is a formal CHOW. One shareholder selling stock to another person is typically reported as a change of information instead. The distinction matters because a CHOW triggers high-risk screening for SNFs, HHAs, and hospices, including fingerprint-based background checks for any new owner.

Five-Year Revalidation

Every enrolled Medicare provider revalidates on a five-year cycle. CMS sets the due date at the end of a specific month and posts it six to seven months in advance through the Medicare Revalidation List, a searchable tool at data.cms.gov.²⁰ If your due date shows as “TBD,” CMS has not set it yet; do not submit a revalidation until an actual date appears.

Revalidation uses the same 855A form and requires the same $750 fee. CMS does not grant extensions, and missing the deadline can deactivate your billing privileges. If deactivated, you must resubmit a complete enrollment application to restore them, and Medicare will not reimburse services furnished during the gap.²¹

1
eCFR. 42 CFR 424.510 – Requirements for Enrolling in the Medicare Program
2
Centers for Medicare & Medicaid Services. National Provider Identifier Standard
3
Centers for Medicare & Medicaid Services. Guidance for SNF Attachment on Form CMS-855A
4
Palmetto GBA. What IRS Documents Are Acceptable?
5
Centers for Medicare & Medicaid Services. CMS 588 – Electronic Funds Transfer (EFT) Authorization Agreement
6
Centers for Medicare & Medicaid Services. CMS-855A Medicare Enrollment Application
7
Centers for Medicare & Medicaid Services. Welcome to the Medicare Provider Enrollment, Chain, and Ownership System
8
CGS Medicare. Top Provider Questions – Provider Enrollment / CMS-855A
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Centers for Medicare & Medicaid Services. MAC Websites, Secure Internet Portals, and Electronic Data Interchange
10
Centers for Medicare & Medicaid Services. Medicare Enrollment Application Information
11
Centers for Medicare & Medicaid Services. Medicare Provider Enrollment
12
eCFR. 42 CFR 424.514 – Application Fee
13
eCFR. 42 CFR 424.518 – Screening Levels for Medicare Providers and Suppliers
14
CGS Medicare. Provider Enrollment Review Process
15
Centers for Medicare & Medicaid Services. Become an Institutional Provider
16
Centers for Medicare & Medicaid Services. Enrollment and Certification Roadmap for Institutional Providers
17
eCFR. 42 CFR 424.530 – Denial of Enrollment in the Medicare Program
18
Centers for Medicare & Medicaid Services. Become a Medicare Provider or Supplier
19
WPS Government Health Administrators. Reporting Changes of Information
20
Centers for Medicare & Medicaid Services Data. Medicare Revalidation List
21
Centers for Medicare & Medicaid Services. Revalidations (Renewing Your Enrollment)