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VERDANT HEALTH COMMISSION PUBLIC HOSPITAL DISTRICT NO. 2 OF SNOHOMISH COUNTY, WASHINGTON BOARD OF COMMISSIONERS Regular Meeting A G E N D A November 20, 2019 8:00 a.m. to 8:55 a.m.A. Call to Order B.

How to fill out to 855 a

How to fill out to 855 a

1. To fill out form 855-A, follow these steps:
2. Start by providing your personal information, such as your name, address, and contact details.
3. Indicate your National Provider Identifier (NPI) number and the date on which you are submitting the form.
4. Specify the Medicare fee-for-service contractor you are submitting the form to.
5. Select the appropriate section and indicate the type of enrollment you are applying for.
6. Provide all the required information for the enrollment category you selected. This may include details about your organization, practice location, billing arrangements, and more.
7. If applicable, submit any supporting documentation along with the form.
8. Review all the information you have provided to ensure accuracy and completeness.
9. Sign and date the form to certify that the information provided is true and accurate.
10. Submit the completed form to the designated Medicare fee-for-service contractor.
11. Keep a copy of the completed form and any supporting documentation for your records.

Who needs to 855 a?

1. Form 855-A is needed by healthcare providers who wish to enroll or make changes to their enrollment in the Medicare fee-for-service program. This form is specifically used for Medicare enrollment of Durable Medical Equipment, Orthotics, Prosthetics, and Supplies (DMEPOS) suppliers. It is necessary for suppliers who provide items or services to Medicare beneficiaries and want to seek reimbursement for those items or services.

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What is to 855 a?

Form 855A is an application for enrollment in the Medicare program as a provider or supplier.

Who is required to file to 855 a?

Entities that wish to enroll in the Medicare program as providers or suppliers must file Form 855A.

How to fill out to 855 a?

To fill out Form 855A, provide accurate information about your organization, including ownership details, billing information, and comply with the specific instructions provided by CMS.

What is the purpose of to 855 a?

The purpose of Form 855A is to collect necessary information for Medicare enrollment and ensure compliance with program requirements.

What information must be reported on to 855 a?

Form 855A requires reporting information such as provider or supplier identification, ownership and control information, billing information, and any relevant legal or disciplinary actions.