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Publish Date: 6/28/2007 How t C H to Complete TH l t the Medicare CMS-855I Disenrollment Application Presented by Provider Outreach & Education and Provider Enrollment Slide 1 Out of 50 Publish Date:

How to fill out 855i - cpm4resultsnet

How to fill out 855i - cpm4resultsnet:

1. Start by accessing the 855i form on the cpm4resultsnet website. You can find it in the "Forms" section or by searching for it using the search bar.
2. Carefully read the instructions provided on the form to understand the requirements and information needed for completion.
3. Begin filling out the form by entering your personal information in the designated sections. This may include your name, address, contact details, and any other requested identifying information.
4. Provide information about your organization or practice. This could include your business name, tax identification number, type of business entity, and any associated certifications or accreditations.
5. Indicate the services or products your organization offers. This may include medical specialties, procedures, or equipment.
6. Complete the sections related to Medicare enrollment. This includes providing your National Provider Identifier (NPI) number, Medicare provider information, and any Medicare billing privileges you currently hold.
7. Fill in the disclosure of ownership and control information. This section requires you to list any individuals or entities that have an ownership or control interest in your organization. Provide their names, addresses, and percentage of ownership or control.
8. Review the completed form for accuracy and ensure all required fields are filled out properly.
9. Sign and date the form to certify the information provided is true and accurate.
10. Submit the completed 855i form as instructed, following any additional submission requirements specified.

Who needs 855i - cpm4resultsnet:

1. Healthcare providers or organizations who wish to enroll in the Medicare system.
2. Medical practitioners, clinics, or facilities who want to bill Medicare for their services or products.
3. Any entity looking to update or make changes to their Medicare enrollment information.

For pdfFiller’s FAQs

What is 855i - cpm4resultsnet?

The form 855i - cpm4resultsnet is an application used to enroll and update the information of healthcare providers in the Medicare program.

Who is required to file 855i - cpm4resultsnet?

Healthcare providers who wish to enroll or update their information in the Medicare program are required to file Form 855i - cpm4resultsnet.

How to fill out 855i - cpm4resultsnet?

To fill out Form 855i - cpm4resultsnet, healthcare providers need to provide their personal and professional information, such as their name, contact details, specialty, and credentials, as well as additional information about the practice location and any affiliations or organizations they are associated with.

What is the purpose of 855i - cpm4resultsnet?

The purpose of Form 855i - cpm4resultsnet is to collect and verify the information of healthcare providers who wish to enroll or update their information in the Medicare program. It helps the Centers for Medicare & Medicaid Services (CMS) maintain an accurate and up-to-date database of participating providers.

What information must be reported on 855i - cpm4resultsnet?

On Form 855i - cpm4resultsnet, healthcare providers must report their personal and professional information, practice location details, affiliations and organizations, as well as any relevant certifications, accreditations, or licenses they hold.

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