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Get Cms-855o 2013
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How to fill out the CMS-855O online
The CMS-855O form is essential for physicians and non-physician practitioners who need to register with Medicare for ordering and referring items and services. This guide will provide clear, step-by-step instructions on how to complete this application online, ensuring a smooth submission process.
Follow the steps to fill out the CMS-855O online effectively.
- Select the ‘Get Form’ button to access the CMS-855O application and open it in the editor.
- Begin with Section 1 to indicate the reason for submitting your application. Check the appropriate box according to your registration purpose.
- In Section 2, provide your identifying information. Ensure to match your details, including name, date of birth, and social security number, with your social security record.
- Section 3 requires information about any final adverse legal actions you may have experienced. Fully disclose any required legal history, as it may impact your registration.
- Complete Section 4 by selecting your medical specialty. Ensure you only check one specialty that accurately reflects your practice.
- In Section 5, provide your correspondence mailing address, which Medicare will use for future communications.
- Designate a contact person in Section 6 who can be reached regarding your application, should the need arise.
- Review Section 7, which outlines the penalties for falsifying information on your application. Understand these implications before proceeding.
- Finally, sign and date Section 8. Ensure your signature is original and in blue ink. Save your completed application once all fields are filled.
Start filling out your CMS-855O application online now to ensure your registration with Medicare is processed efficiently.
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To acquire a Medicare provider number, you must first complete and submit the CMS-855O form. This form verifies your eligibility and outlines the necessary details about your organization. Once approved, you will receive your Medicare provider number, allowing you to bill Medicare for services provided.
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