Get Form Cms-855a Medicare Enrollment Application

The Form CMS-855A Medicare Enrollment Application is essential for institutional providers to enroll in the Medicare program and obtain a Medicare billing number. This guide provides a step-by-step approach to filling out the form online effectively.

Follow the steps to complete the CMS-855A form online:

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully read the instructions to determine if this is the correct application for your situation.
3. Complete Section 1, providing your basic information including the reason for submitting the application.
4. Complete Section 2 with identifying information, including your legal business name and National Provider Identifier (NPI).
5. Fill out Section 3 regarding any final adverse legal actions, ensuring to provide complete and accurate details.
6. Provide details about your practice locations in Section 4, listing all facilities where services will be rendered.
7. In Section 5, report ownership interest and managing control if applicable, detailing any organizations with ownership stakes.
8. Complete Section 6 for individuals with ownership interest or managing control, ensuring to include all relevant individuals.
9. If using a billing agency, fill out Section 8 with the billing agency information. Otherwise, you may skip this section.
10. Verify all entries are complete, accurate and that required supporting documentation is attached.
11. Finally, save changes, download, print, or share the completed form as needed.

Start completing your Form CMS-855A online to ensure your Medicare enrollment process is smooth and efficient.