Get 855i Form

Filling out the CMS-855i Form online is an essential step for physicians and non-physician practitioners looking to revalidate their enrollment with Medicare. This guide provides a straightforward approach to help users navigate the various sections of the form effectively.

Follow the steps to complete the 855i Form online with ease.

1. Press the ‘Get Form’ button to access the form and open it in the designated online editor.
2. In Section 1A, ensure that you include all individual Medicare identification numbers (PTANs) that need revalidation. Each PTAN must be associated with the respective National Provider Identifier (NPI) at the upper portion of this section, and remember to check the revalidation box.
3. Moving to Section 2, complete sections 2A, 2B, and 2C fully as these apply to all 855i application processes. Provide accurate information regarding your specialty in section 2D1 and reassignments in section 2H, if applicable.
4. For Section 3, evaluate if you need to answer 'Yes' to Section 3.1. If answered affirmatively, make sure to complete Section 3.2 accordingly, as a simple note of 'See Attached' is not acceptable.
5. Section 4B requires that you fill out all association information related to the entities you're associating with. Ensure completeness for every PTAN listed in Section 1A.
6. In Section 15, provide the original and dated signature of the individual indicated in Section 2 of the application. This signature is vital for the validity of your submission.
7. Once all sections are completed, look for any additional documentation required as indicated in the attachments checklist and ensure those are also submitted.
8. Finally, after reviewing all inputted data for accuracy, you can save your changes, download, print, or share the completed form as necessary to fulfill your revalidation process.

Start filling out the 855i Form online today to ensure your Medicare enrollment remains active.