HHS CMS-855I 2011 free printable template

MEdiCarE EnrollMEnt aPPliCationPhySiCianS and nonPhySiCian PraCtitionErSCMS855iSEE PagE 1 to dEtErMinE if you arE CoMPlEting thE CorrECt aPPliCation. SEE PagE 2 for inforMation on whErE to Mail thiS

How to fill out HHS CMS-855I

How to fill out HHS CMS-855I

1. Obtain the HHS CMS-855I form from the CMS website or your local Medicare office.
2. Fill out Section 1: Type of Application, indicating whether it's an initial application or a revalidation.
3. Complete Section 2: Basic Information, providing your legal name, Social Security number, and other personal identification.
4. Fill out Section 3: Practice Location, including the address where you provide medical services.
5. Provide detailed information in Section 4: Provider Information, including your NPI and credentials.
6. Review Section 5: Ownership and Control Information, disclosing any affiliations or ownership interests.
7. If applicable, complete Section 6: Provider Enrollment, specifying the services you will be providing.
8. Submit supporting documentation as required, such as medical licenses and certifications.
9. Review all entries to ensure accuracy, then sign and date the application at the end.
10. Send the completed form and supporting documents to the appropriate Medicare Administrative Contractor (MAC).

Who needs HHS CMS-855I?

1. Healthcare providers who wish to enroll in the Medicare program.
2. Individual practitioners who need to provide services to Medicare beneficiaries.
3. Entities such as group practices or clinics that require Medicare enrollment.

Instructions and Help about HHS CMS-855I

Hello my name is Gary Street I'm a chiropractor from the southern part of Illinois and the subject we're going to talk about the day is chiropractic Medicare and it's really called a CMS 855 I application this is an application that all new practitioners if you graduated McCarthy college the first thing you want to do is download off of the CMS website and 855 I application and get to work on it it's about 30 pages long however you must complete this application and mail it certified mail to the Medicare carrier prior to actually seen any medicare patient if you're a practitioner that has been in practice for a number of years if you've not completed a CMS a 55 I application for an individual solo practice then you need to download this and do it now if you're a corporation you two need to download a CMS 8 55 f and complete that for your corporation so that everything is registered with your Medicare carrier if you change your address if you move across the street and change any data in the location your phone number you must update this application with the Medicare carrier this and much more information you can find on our website at wwlp.com or you can always call us at one eight hundred my chiro thank you you

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What is HHS CMS-855I?

The HHS CMS-855I is a form used by healthcare providers to enroll in Medicare as an individual practitioner. It collects essential information needed to determine eligibility for Medicare participation.

Who is required to file HHS CMS-855I?

Healthcare providers, including physicians, non-physician practitioners, and suppliers who intend to bill Medicare for services provided to beneficiaries, are required to file the HHS CMS-855I.

How to fill out HHS CMS-855I?

To fill out HHS CMS-855I, applicants must provide personal and professional information, including personal identification details, practice location, and credentials. The form can be completed online or via paper, and it requires signatures and supporting documentation.

What is the purpose of HHS CMS-855I?

The purpose of HHS CMS-855I is to enable individual healthcare providers to officially enroll in the Medicare program, facilitating their ability to bill Medicare for services provided to eligible beneficiaries.

What information must be reported on HHS CMS-855I?

The HHS CMS-855I requires reporting of personal identification information, National Provider Identifier (NPI), tax identification number, details about the provider’s practice, and any previous affiliations with Medicare or other healthcare programs.