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CMS-855 Enrollment Application Revalidation Checklist Please return this checklist on the TOP of your submission to properly identify your application. Provider Name: NPI: PLAN: Checklist for both

How to fill out cms-855 enrollment application revalidation

How to fill out CMS-855 enrollment application revalidation:

1. Start by downloading the CMS-855 enrollment application revalidation form from the Centers for Medicare & Medicaid Services (CMS) website.
2. Read the instructions carefully before filling out the form. Make sure you understand all the requirements and provide accurate information.
3. Begin by providing your personal information such as your name, contact details, and social security number.
4. Fill out the section that asks for your enrollment information, including your National Provider Identifier (NPI) and any other identifying numbers.
5. Provide details about your practice location, including the address, phone number, and other contact information.
6. Include information about your billing agency or service provider if applicable.
7. Fill out the sections related to your specialty or specialties, including any certifications or licenses you hold.
8. Provide information about your practice structure, such as whether you are a sole proprietor or part of a group practice.
9. Answer the questions related to Medicare/Medicaid participation, revalidation reasons, and any previous adverse legal actions.
10. Complete any other sections that are relevant to your particular situation, such as supplier standards or ownership information.

Who needs CMS-855 enrollment application revalidation:

1. Healthcare providers or suppliers who are currently enrolled in the Medicare program and need to revalidate their enrollment information.
2. This process helps ensure that the provider or supplier's information is up to date and accurate, and that they meet all the Medicare enrollment requirements.
3. Providers or suppliers who have had changes in their practice or billing information, or who have not revalidated their information within the specified time frame, are required to complete the CMS-855 enrollment application revalidation.

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What is cms-855 enrollment application revalidation?

The CMS-855 enrollment application revalidation is a process that healthcare providers must undergo to confirm their enrollment status and ensure that they continue to meet the eligibility criteria set by Medicare.

Who is required to file cms-855 enrollment application revalidation?

All Medicare-enrolled providers and suppliers are required to file the CMS-855 enrollment application revalidation, especially when their enrollment status has been inactive for a certain period or when asked by CMS to do so.

How to fill out cms-855 enrollment application revalidation?

To fill out the CMS-855 enrollment application revalidation, providers must complete the appropriate sections of the CMS-855 form, ensuring that all information is accurate and up-to-date. It can typically be submitted online through the Provider Enrollment, Chain, and Ownership System (PECOS) or by mail.

What is the purpose of cms-855 enrollment application revalidation?

The purpose of CMS-855 enrollment application revalidation is to verify the continued eligibility of healthcare providers and suppliers for Medicare reimbursement, ensuring compliance with Medicare regulations and preventing fraudulent activities.

What information must be reported on cms-855 enrollment application revalidation?

The CMS-855 enrollment application revalidation must report essential information such as the provider's legal business name, tax identification number, practice location, services offered, and any changes in ownership or management.