We want to make our customers in Maryland and the District of Columbia aware of the proper procedure for updating their address with Highmark Medicare Services.
Changes of address should be communicated to Medicare contractors via use of the standard CMS 855A enrollment form. The request must be made by either the provider or an authorized/delegated official on file. If the provider has an 855A enrollment form on file with the contractor, then they may complete only those sections of the 855A that are used for a change of address. They sections needed are as follows:
|
Change of Practice Location Address |
Change of ‘Pay To’ Address |
|
Section 1-A |
Section 1-A |
|
Section 4-A |
Section 4-F |
|
Section 15 (Signature and Date) |
Section 15 (Signature and Date) |
After completing the 855A to requests a change of address, please mail it to:
Highmark Medicare Services
Attn: Provider Enrollment Services
PO Box 890386
Camp Hill, PA 17089-0386
Forms can be obtained at that CMS website at: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp.
Contractors are required to collect an entire 855A application if the provider has not previously submitted an 855A enrollment form to the fiscal intermediary.
NOTE: Those 855A enrollment forms that were on file with CareFirst previous to the transition have been received by Highmark Medicare Services.
Questions on how to fill out the 855A forms can be directed to our enrollment help line at 1-866-488-0549.