Revised CMS-855R Medicare Benefits Reassignment Application

Physicians and non-physician practitioners must use the revised CMS-855R (Reassignment of Benefits) application beginning January 1, 2017. Per the Centers of Medicare and Medicaid, Medicare Administrative Contractors can no longer accept the (11/12) version of the application as of December 31, 2016. The revised form makes the primary practice location section optional. However, this information is shared with other organizations, such as the Comparative Initiative, to help beneficiaries identify your practice. For more information, please refer to the September 22, 2016 MLN Connects Provider eNews.


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