The CMS-855 form is the gateway to Medicare and Medicaid enrollment. Getting it right the first time saves months of delays.
What Is the CMS-855?
The CMS-855 is the federal provider enrollment application used by CMS to screen and enroll providers. For home care agencies, you'll typically complete the CMS-855A (institutional providers).
Before You Start: Prerequisites
- State home care/home health license — active and in good standing
- National Provider Identifier (NPI) — Type 2 organizational NPI
- Employer Identification Number (EIN)
- Business entity documentation
- Insurance certificates
- Surety bond — $50,000 for home health agencies
Section-by-Section Walkthrough
Section 1: Basic Information
- Legal Business Name — must exactly match IRS records and state license
- DBA name — if different from legal name
- Tax Identification Number — must match IRS Form CP-575
- NPI Number — your Type 2 organizational NPI
- Provider type — select "Home Health Agency"
Critical: Any mismatch between legal name, EIN, and NPI causes automatic rejection.
Section 2: Practice Location
- Main office address — must be a physical location (no P.O. boxes)
- Branch offices — each requires separate enrollment
- Phone and fax numbers — CMS will call to verify
Your office must be ready for unannounced site visits — open during business hours, staffed, with patient records and policies available.
Section 3: Adverse Legal Actions
Disclose federal or state felony convictions, Medicare/Medicaid exclusions, license revocations, and civil monetary penalties. Be thorough — failure to disclose is grounds for denial and potential fraud charges.
Section 4: Business Structure
Indicate your organizational type: sole proprietorship, partnership, corporation, LLC, or non-profit.
Section 5: Ownership Interest and Managing Control
The most scrutinized section. Disclose:
- Direct ownership — anyone with 5%+ direct ownership
- Indirect ownership — through another entity
- Managing employees — officers, directors, operational managers
- Required info: full name, SSN, DOB, home address, ownership percentage, title
Section 6: Billing Information
- Electronic Funds Transfer (EFT) setup — required for Medicare
- Bank account information
- Billing agent info if using a billing company
Section 7: Certification Statement
The authorized official signs affirming all information is true, the organization will comply with all laws, and the signer has authority to bind the organization.
Submitting Your Application
PECOS (recommended): Online submission at pecos.cms.hhs.gov — faster processing and easier tracking.
Paper submission: Mail to your Medicare Administrative Contractor (MAC) — slower but available.
Timeline After Submission
| Step | Timeline |
|---|---|
| Acknowledgment | 1–2 weeks |
| Initial review | 30–60 days |
| Information request (if needed) | Adds 30+ days |
| Site visit | 2–4 weeks to schedule |
| Final determination | 30–60 days after visit |
| Total | 3–6 months |
Tips for First-Time Success
- Triple-check legal name, EIN, and NPI match
- Disclose everything — hiding information is worse than disclosing it
- Respond to information requests within 30 days
- Keep your office ready for unannounced visits
- Use PECOS for faster processing
Need Help?
Book a Free Clarity Call → — Get expert guidance on your enrollment application.
Watch Our Free Webinar → — Learn the complete process for launching a home care agency.
Agency in a Box — $5,000 → — Includes enrollment guidance and complete launch support.
Information is for educational purposes. CMS forms and requirements change — always verify at cms.gov.