Get Cms Mln 6325432 2020-2025

This guide provides a comprehensive overview of how to accurately fill out the CMS MLN 6325432 form. It is designed to assist Opioid Treatment Programs (OTPs) in navigating the online enrollment process required for Medicare.

Follow the steps to complete the CMS MLN 6325432 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by gathering all necessary documents, including NPI, ownership information, and organizational details required for completing the form.
3. Complete Section 1: Basic Information, where you will provide your Medicare Identification Number and NPI.
4. Fill out Section 2: Identifying Information, ensuring to include relevant details about your organization and SAMHSA certification status.
5. Go to Section 3: Final Adverse Legal Actions/Convictions, and disclose any legal actions if applicable.
6. In Section 4: Practice Location Information, provide details of all locations where services will be provided.
7. Complete Sections 5 and 6: Ownership Interest and/or Managing Control Information, detailing any organizations or individuals with ownership interests.
8. If applicable, fill out Section 8 for Billing Agency Information and include any billing agencies involved.
9. Select a contact person in Section 13, providing their contact details for inquiries.
10. Review and certify the information provided by signing Section 15: Certification Statement.
11. Once the form is fully completed and reviewed, submit the form and any required supporting documentation online.
12. After submission, track the application status, and respond promptly to any requests for additional information from your MAC.

Start completing your CMS MLN 6325432 form online today to ensure a smooth enrollment process.