Get Cms-855r 2020-2025

The CMS-855R form is essential for practitioners seeking to reassign Medicare benefits or terminate a current reassignment. This guide provides clear and supportive instructions for completing the form online, ensuring that all users, regardless of experience, can navigate the process effectively.

Follow the steps to complete your CMS-855R application online.

1. Click the ‘Get Form’ button to access the CMS-855R and open it for completion.
2. Begin by filling out Section 1, which captures basic information about the reason for submitting this application. Choose the applicable box for reassignment or termination and provide the effective date.
3. In Section 2, provide details about the organization or group receiving the reassign benefits. Ensure that the legal business name matches IRS documents and include tax identification numbers where applicable.
4. Section 3 requires information about the individual practitioner. Fill in their name, social security number, and national provider identifier, ensuring accuracy to avoid delays.
5. If applicable, Section 4 allows you to list the primary and secondary practice locations. Designate if you are adding, changing, or removing this information, and provide the required addresses.
6. Provide any contact person information in Section 5. This is optional, but having a designated contact can facilitate communication if questions arise during processing.
7. Complete Section 6 with the required certification statements. Both the individual practitioner and an authorized official from the organization/group must sign and date this section for the application to be valid.
8. Once you have filled out all required sections accurately, save the changes to your application. You may then download, print, or share the completed CMS-855R form as needed.

Complete your CMS-855R application online today for efficient processing of your Medicare reassignments.