Get Hhs Cms-855i 2018-2025

The HHS CMS-855I is a crucial enrollment application for physicians and non-physician practitioners looking to participate in the Medicare program. This guide provides step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the HHS CMS-855I online process.

1. Press the ‘Get Form’ button to access the CMS-855I and open it in your online document editor.
2. Carefully read page 1 to confirm that you are completing the correct application as per your enrollment needs.
3. Provide your basic information in Section 1. Indicate the reason for submitting the application by checking the appropriate box.
4. Complete Section 2, which includes personal identifying information. Ensure that your name, date of birth, and Social Security number match your official records.
5. Fill in section 3 regarding any final adverse legal actions you may have experienced. This is crucial for your enrollment process.
6. In Section 4, provide business information if applicable, including details about your practice location and billing agency.
7. Review all information for accuracy and completeness. Any missing information could delay your application.
8. Attach any required supporting documentation as outlined on page 4.
9. Sign Section 15 certifying that all information provided is true, complete, and acknowledges the penalties for false information.
10. Save your completed form, then proceed to download, print, or share as necessary for submission.

Start filling out your HHS CMS-855I online today to ensure your Medicare enrollment!