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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Medicare Part D Prior Authorization Department P.O. Box 419069 Rancho Cordova, CA

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What is formscms - centers for?

Form CMS-855 is a series of applications used by healthcare providers to enroll in the Medicare Program or to make changes to their enrollment data.

Who is required to file formscms - centers for?

Healthcare providers and suppliers who wish to enroll in the Medicare program or update their enrollment information are required to file Form CMS-855.

How to fill out formscms - centers for?

To fill out Form CMS-855, applicants must provide personal and business information, including Medicare identification, tax information, and specific details about their healthcare services.

What is the purpose of formscms - centers for?

The purpose of Form CMS-855 is to facilitate the enrollment process of healthcare providers and suppliers in the Medicare program, ensuring compliance and proper identification.

What information must be reported on formscms - centers for?

Information that must be reported includes provider identification, practice location, ownership details, and any affiliation with other healthcare organizations.