Form CMS-855B –Medicare Enrollment Application for Clinics,

10.3.1.2 – Form CMS-855B –Medicare Enrollment Application for Clinics, Group Practices, and Certain Other Suppliers (Rev. 11839; Issued: 02-09-23; Effective: 04-21-23; Implementation: 06-19-23) This application should be completed by supplier organizations (e.g., ambulance companies) that will bill Medicare for Part B services furnished to Medicare beneficiaries. It is not used to enroll individuals. The policies in this section 10.3.1.2 et seq. apply exclusively to the Form CMS-855B (except as otherwise noted).