Effective January 4, 2021, an updated version of the CMS-855B (07/23) application form will be available for clinics, group practices, and other suppliers who have a Type 2 NPI.

Medicare will accept version (07/11) of the CMS-855B application form until March 31, 2021; however, will be returned to the provider if submitted after this date.

Visit the Noridian Enrollment Forms webpage to access the updated CMS-855B application form.