Home Health Agency (HHA) Doing Business As (DBA) Name Change

Provide written notice on letterhead and include the following:

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Previous DBA name
• New DBA
• Effective date of change
• Notice will be signed by HHA official

Contact the Minnesota Secretary of State and file a Certificate of Assumed Name. 

• See Minnesota Secretary of State

If deemed status, the HHA will notify the accrediting organization of the dba name change.

Submit CMS 855A application to the designated Medicare Administrative Contractor (MAC) for the approval.

• CMS 855A Medicare Enrollment Application (PDF)
• Medicare Fee-for-Service Provider Enrollment Contact List

Any questions please email:  Health.HRD-FedLCR@state.mn.us