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Get Cms-855s 2011
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How to fill out the CMS-855S online
The CMS-855S is an essential application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers to enroll in the Medicare program. This guide will provide you with step-by-step instructions to help you effectively complete the form online.
Follow the steps to successfully fill out your CMS-855S application
- Click the ‘Get Form’ button to obtain the CMS-855S and open it for editing.
- Begin by providing your business location details in Section 1, ensuring to include the state code and legal business name as reported to the IRS.
- In Section 2, enter your business location information, including the specific street address, contact details, and hours of operation.
- Fill out Section 3 by selecting the type of supplier and entering necessary accreditation information, making sure to indicate any relevant product and service offerings.
- Provide your liability insurance information in Section 5, ensuring your coverage meets the Medicare requirement of at least $300,000.
- Complete Section 6 regarding surety bond information if applicable, or indicate that you are not required to obtain a surety bond.
- In Section 7, report any final adverse legal actions, if applicable, ensuring complete transparency.
- Move to Section 8 and provide ownership interest and controlling entities, including necessary details about organizations and individuals with ownership interests.
- In Section 9, enter the details of individuals who hold ownership interests or managing control, and report any final adverse legal actions if needed.
- Complete all applicable sections, ensuring you provide accurate and comprehensive documentation in Section 12.
- Once all sections are filled out, carefully review your application for accuracy, and prepare to submit it to the appropriate NSC MAC address provided in the instructions.
- You can save changes, download, print, or share the form as necessary.
Start completing your CMS-855S application online today to ensure your enrollment in the Medicare program.
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855S is the specific form used by suppliers of durable medical equipment to enroll in the Medicare program. It includes detailed sections that capture essential information about the supplier's business and credentials. Utilizing platforms like uslegalforms can simplify the completion of CMS855S, helping you navigate the enrollment process more efficiently.
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