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How to fill out cms855i form

How to fill out CMS855i:

1. Begin by gathering all necessary information and documentation, such as your National Provider Identifier (NPI) number, tax identification number, and any applicable licenses or certifications.
2. Access the CMS855i form, which can typically be found on the Centers for Medicare & Medicaid Services (CMS) website or through your regional Medicare Administrative Contractor (MAC).
3. Carefully read the instructions provided with the form to ensure you understand the requirements and sections that need to be completed. Familiarize yourself with any specific guidelines or documentation that may be required for your particular type of enrollment.
4. Start filling out the form section by section. Begin with the Provider Information section, which will require you to provide details about your practice or organization, such as the legal business name, address, and contact information.
5. Proceed to the Ownership/Controlling Interest section, where you will need to disclose any individuals or organizations that have any ownership or controlling interests in your practice or organization. This may include shareholders, partners, or board members. Be sure to provide accurate and complete information for each entity.
6. Move on to the Authorized Official section, where you will need to provide the details of the individual who is authorized to complete and sign the form on behalf of your practice or organization. This person should have the legal authority to bind your entity to the terms and conditions of the CMS enrollment process.
7. The next section is the Managing Employees section, where you will be asked to provide information about your employees, such as their names, titles, and roles within your practice or organization. This section may also require you to disclose any excluded individuals or entities.
8. Continue filling out the remaining sections of the form, including the Financial Information, Disclosures, and Certifications. Each section will require you to provide specific details and may require supporting documentation, such as financial statements or copies of licenses.
9. Once you have completed all sections of the form, review your answers carefully. Make sure all information is accurate and up to date. Any false or misleading information can result in delays or denial of your enrollment application.
10. Sign and date the form, either manually or using an electronic signature if applicable. Ensure that the Authorized Official has also signed and dated the form.

Who needs CMS855i?

1. Healthcare providers or organizations that wish to enroll or revalidate their enrollment in the Medicare program need to complete and submit the CMS855i form. This includes individual healthcare practitioners, group practices, clinics, and other healthcare entities.
2. Typically, CMS855i is required for providers who render services and bill Medicare on a fee-for-service basis. It is necessary for providers seeking Medicare Part B billing privileges, which include services such as physician services, outpatient care, laboratory tests, durable medical equipment, and more.
3. The CMS855i form is not required for providers who are already enrolled in Medicare and only need to update their existing information. In such cases, providers may be required to complete other enrollment forms specific to their changes, such as the CMS855r for reassignments or the CMS855b for changes of ownership.

Remember, the completion and submission of the CMS855i form is an essential step in obtaining Medicare billing privileges, so ensure accurate and thorough completion to avoid unnecessary delays or denials in the enrollment process.

For pdfFiller’s FAQs

What is cms855i?

CMS-855i is a Medicare enrollment application for individual providers who are eligible to enroll or already enrolled in the Medicare program.

Who is required to file cms855i?

Individual healthcare providers such as physicians, non-physician practitioners, and other eligible professionals who want to enroll in the Medicare program or make changes to their existing enrollment information are required to file CMS-855i.

How to fill out cms855i?

The CMS-855i form can be filled out online through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or by completing a paper application and submitting it by mail.

What is the purpose of cms855i?

The purpose of CMS-855i is to collect and maintain provider enrollment information in order to ensure that only eligible providers are able to bill Medicare for their services.

What information must be reported on cms855i?

The CMS-855i form requires providers to report their personal and professional information, credentials, practice locations, and any other relevant information needed for enrollment in the Medicare program.

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