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CMS-855I: Who needs to sign the CMS-855I for a reassignment?

Section 15: CERTIFICATION STATEMENT AND SIGNATURE

If adding a reassignment both the individual provider(15B) and the authorized/delegated official of the group (15C) need to sign and date.

  • If a Physician Assistant is adding an employment arrangement no 15C is needed.

If terminating/changing a reassignment either the individual provider(15B) OR the authorized/delegated official of the group (15C) need to sign and date.
Signature Field for section 15