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Get Hhs Cms-855i 2011
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How to fill out the HHS CMS-855I online
Completing the HHS CMS-855I is an essential step for physicians and non-physician practitioners looking to enroll in the Medicare program. This guide provides clear, step-by-step instructions to assist you in filling out the form online effectively.
Follow the steps to successfully complete your HHS CMS-855I application.
- Press the ‘Get Form’ button to access the CMS-855I document and open it in your preferred online editor.
- Begin by reviewing the initial sections of the form to confirm that you are completing the correct application. Ensure all necessary supporting documentation is available.
- In Section 1, Basic Information, identify whether you are a new enrollee, reactivating your enrollment, or making changes. Complete the required fields based on your circumstances.
- Move to Section 2, Identifying Information. Accurately input your personal information, including your name, date of birth, social security number, and any professional credentials. Ensure all details match your official records.
- Continue to Section 3, where you will disclose any final adverse legal actions or convictions. This step is crucial as it assesses your eligibility.
- In Section 4, provide your Practice Location Information. List all addresses where you render services, ensuring compliance with the Medicare requirements.
- Fill out Sections 6 to 12 as required, detailing any managing control individuals and billing agency information, if applicable.
- Complete the contact person section in Section 13, providing reliable contact information for follow-up if needed.
- Review the Penalties for Falsifying Information section to understand the implications of providing incorrect information.
- Sign the Certification Statement in Section 15, ensuring your signature is in original ink. All required signatures must be completed for application acceptance.
- Finally, save your completed CMS-855I application. You can download, print, or share the form as necessary.
Begin your online application for the HHS CMS-855I today.
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To upload documents for your PECOS application, first log into your account on the PECOS platform. Once logged in, you will find options for document uploads during the application process. Using the HHS CMS-855I effectively incorporates your documents, which ensures a smoother submission, potentially accelerating your Medicare enrollment.
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