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                Get Cms-855o 2017-2025
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How to fill out the CMS-855O online
The CMS-855O form is essential for physicians and eligible professionals to enroll in the Medicare program for the purpose of ordering or certifying items and services. This guide provides a clear, step-by-step process to assist users in completing the form accurately and online.
Follow the steps to complete the CMS-855O online.
- Press the ‘Get Form’ button to retrieve the CMS-855O document and open it in your editing tool.
 - Begin with Section 1, where you will indicate the reason for submitting the application. Select the appropriate box to specify if you are enrolling, updating information, or withdrawing.
 - Move to Section 2, identifying your personal details. Fill in your first name, middle initial, last name, date of birth, and social security number. Ensure that these match with your social security records.
 - Complete your educational information in Section 2B by providing details of your medical or professional school and the year of graduation.
 - In Section 2C, enter your license, certification, and registration information. Include your license number, effective date, and the state where it was issued.
 - Address any final adverse legal actions in Section 3, which captures necessary information about any legal convictions or penalties that may impact your enrollment.
 - Check your medical specialty in Section 4. Ensure that you only select one specialty that corresponds to your qualifications and state requirements.
 - Provide your correspondence mailing address in Section 5. This is the address that the Medicare Administrative Contractor will use for future correspondence.
 - If applicable, complete Section 6 with the contact person’s information, who can be reached regarding questions about this application.
 - Review Section 7, which outlines the penalties for falsifying information. Understand the implications of providing inaccurate data.
 - Finally, in Section 8, sign and date the certification statement confirming the accuracy of the information provided and your agreement to adhere to Medicare requirements.
 - Once completed, save your changes, download the document, and consider printing or sharing the form for your records.
 
Start filling out your CMS-855O online now and ensure your eligibility for Medicare services.
Related links form
To obtain a Medicare provider number, you need to complete the CMS-855O application. This form includes essential information about your practice and your qualifications. After submitting the application and receiving approval, you will be issued a Medicare provider number, allowing you to bill Medicare directly.
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