and Human Services will render the amount claimed in the cost report unallowable. A. Provider Organization and Operation NOTE: Section A to be completed by all providers. 1. The provider has: a. Changed ownership. If "yes", submit name and address of new owner, date of change, copy of sales agreement, or any similar agreement affecting change of ownership. b. Terminated participation. If "yes", list date of termination, and reason (Voluntary/Involuntary). 2. The provider, members of the bo.
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How to fill out the CMS-339 online
Filling out the CMS-339 form online can be straightforward with the right guidance. This comprehensive guide is designed to walk users through each section of the form, ensuring that the information is accurately represented and complete.
Follow the steps to complete the CMS-339 form online.
- Click ‘Get Form’ button to obtain the CMS-339 form and open it in the online editor.
- Begin by entering the provider name and provider number(s) in the designated fields. Ensure that all entries are accurate to avoid issues with your submission.
- For the cost report period, specify the start and end dates clearly. This information is critical for reviewing financial data.
- Proceed to Section A and answer the questions regarding provider organization and operation. If there have been changes in ownership or termination, provide the necessary details.
- In Section B, fill out financial data, indicating if the statements were audited, compiled, or reviewed. Attach supporting documents as required.
- For Sections C through L, carefully respond to each question, providing any required attachments or explanations where indicated.
- Once all sections are completed, review your entries for accuracy and completeness. Make any necessary corrections before proceeding.
- At the end of the form, you will have options to save changes, download, print, or share your form online. Select the appropriate option based on your needs.
Complete and submit the CMS-339 form online to ensure timely processing and compliance.
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