Get Transmittal B-01-24 - Cms

Filling out the Transmittal B-01-24 - Cms form is essential for multi-state mass immunizers wishing to participate in centralized billing for influenza and pneumococcal vaccinations. This guide provides a clear, step-by-step approach to assist you in completing the form accurately and efficiently.

Follow the steps to complete the Transmittal B-01-24 - Cms form online

1. Click ‘Get Form’ button to obtain the Transmittal B-01-24 - Cms and open it in your online document editor.
2. Begin with Section 1: Provider Information. Enter the name and address of your organization, including the zip code. Ensure that all details are accurate to avoid any delays in processing.
3. Proceed to Section 2: Contact Information. Fill in the email, phone number, and designated contact person for any correspondence regarding your application.
4. In Section 3: Centralized Billing Agreement, read the criteria listed carefully. Confirm your understanding and agreement by signing in the designated area. Ensure that you meet all requirements before proceeding.
5. Complete Section 4: Estimates of Beneficiary Vaccinations. Input estimates for the total number of beneficiaries who will receive both influenza and pneumococcal vaccinations along with the approximate dates and locations for these clinics.
6. Fill out Section 5: Service Information. Describe the types of services your organization provides, and specify whether the administering nurses will be employees or hired specifically for the vaccination purpose.
7. Review all entries across each section. Accurate information is crucial for your participation in the centralized billing program.
8. Finally, save your changes, and choose to download or print the completed form for your records. You may also share the form as necessary.

Complete your Transmittal B-01-24 - Cms form online to ensure a smooth participation in the centralized billing program.