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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:7/8/2020 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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Gather all necessary information such as personal details, insurance information, and medical history.
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Visit the Centers for Medicare & Medicaid Services website and navigate to the enrollment section.
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Choose the appropriate enrollment form based on your circumstances (e.g. initial enrollment, enrollment in a Medicare Advantage plan, etc.).
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Fill out the form completely and accurately, making sure to provide all required information.
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Submit the form either online, by mail, or in person at a local Medicare office.

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Individuals who are eligible for Medicare benefits
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Those seeking to make changes to their current Medicare coverage
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The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid.
Healthcare providers, suppliers, and certain other entities that participate in the Medicare program are required to file Centers for Medicare & Medicaid Services (CMS) forms.
Centers for Medicare & Medicaid Services (CMS) forms can be filled out electronically through the CMS website or submitted via mail.
The purpose of Centers for Medicare & Medicaid Services (CMS) forms is to collect data and information necessary for administering the Medicare program.
Centers for Medicare & Medicaid Services (CMS) forms typically require information about services provided, billing codes, and patient demographics.
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