Engaging the National Supplier Clearinghouse: CMS 855S Enrollment Form
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Engaging the National Supplier Clearinghouse: CMS 855S Enrollment Form

Over the past month,CIGNA Government Services have identified a higher than normal volume of mail being returned as "undeliverable."  CIGNA has determined that the majority of the "undeliverable" mail is being returned as a result of suppliers not engaging the National Supplier Clearinghouse (NSC) when there is a change to either their address or any of the other information provided on the CMS 855S enrollment form.  Engaging the NSC is a critical step in allowing the processing of your claims and meet your needs.

Supplier standard #2 requires suppliers to notify the NSC of any change to the information provided on the CMS 855S within 30 days.  All changes of information including address changes must be reported on the CMS-855S enrollment form.  Suppliers must submit sections 1B, 1C, 2A1, 3, 4, 13, and either 15 or 16 (if the delegated official is on file and is authorizing the change) to the NSC to report address changes. For changes to other information on the CMS 855S form, please visit http://www.cignagovernmentservices.com/medicare_dynamic/leaveCIGNA.asp?link=http://www.palmettogba.com/nsc to receive complete instructions.  Suppliers who do not report updated information are subject to the revocation of their Medicare billing privileges by the NSC.

You may request a redetermination by submitting a completed Medicare DME MAC Jurisdiction C Redetermination Request Form.  This can be found on our DME MAC Jurisdiction C Forms page.

Additional information you wish to be considered during the redetermination should be mailed with the written redetermination request. Redetermination requests should be mailed to:

CIGNA Government Services
DME MAC Jurisdiction C
P.O. Box 20009
Nashville, TN 37202


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