Get Cms 855s Form

This guide provides a comprehensive overview of the steps necessary to complete the CMS 855S form online, which is essential for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers to enroll in the Medicare program. Follow the instructions carefully to ensure a smooth and accurate submission.

Follow the steps to fill out the CMS 855S form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling in Section 1, Basic Information. This includes providing your business location, Legal Business Name (LBN), National Provider Identifier (NPI), and Tax Identification Number (TIN). Ensure that these details match those associated with your NPI.
3. In Section 2, identify your business location and hours of operation. Include specific street addresses and ensure they are compliant with the USPS standards.
4. Move on to Section 3 and specify the type of supplier and accreditation information. Ensure that you include all applicable licenses and certificates.
5. Complete Section 4, providing necessary mailing addresses for 1099, correspondence, revalidation requests, and remittance notices.
6. In Section 5, supply information about comprehensive liability insurance. You will need to provide documentation proving compliance.
7. Fill out Section 6 regarding surety bond information, if applicable. Provide necessary details and attach required documents.
8. Complete Section 7 by disclosing any final adverse legal actions that may impact your application.
9. Sections 8 and 9 require you to provide information about ownership interest and managing control for organizations and individuals, respectively.
10. Fill Section 10 if a billing agency is involved, providing their contact information and TIN.
11. Ensure that Section 11 identifies a contact person for any questions related to your application.
12. Before submitting, refer to Section 12 to ensure you have all necessary supporting documents attached as specified.
13. After thoroughly reviewing the information for accuracy, proceed to Sections 14 and 15 for delegation of officials and authorized official certification.
14. Finally, save your changes, download a copy of the completed form, print it if necessary, and follow the instructions for submission.

Complete your CMS 855S form online today for a hassle-free Medicare enrollment.