Get Cms-855 Enrollment Application Revalidation ... - Palmetto Gba

The CMS-855 Enrollment Application Revalidation is an essential form for healthcare providers to maintain their Medicare enrollment. This guide offers comprehensive, step-by-step guidance for users navigating the revalidation process online.

Follow the steps to successfully complete your CMS-855 Enrollment Application Revalidation.

1. Press the ‘Get Form’ button to access the CMS-855 Enrollment Application Revalidation. This allows you to open the form in an interactive editor.
2. Review Section 1A, which confirms that you are revalidating your Medicare enrollment. Ensure that you check the box indicating your intent to revalidate.
3. List all practice locations associated with your Medicare enrollment. This is essential for accurate identification and processing.
4. Document all National Provider Identifiers (NPIs) relevant to your enrollment to ensure full transparency.
5. Provide all final Adverse Action documentation, including notifications, resolutions, and reinstatement letters, to attest to your compliance.
6. Submit IRS documentation confirming your legal business name, such as CP 575, 941, or LTR 1477C, if relevant.
7. Once all sections are filled and documents attached, save your changes, then download, print, or share your completed application as needed.

Begin your CMS-855 Enrollment Application Revalidation process now by filling out the form online.