Get Cms-855a 2024-2025

The CMS-855A application is essential for institutional providers to enroll in the Medicare program. This guide provides a clear, step-by-step approach to successfully complete the form online, ensuring you submit a comprehensive application with all required information.

Follow the steps to complete the CMS-855A online.

1. Click the ‘Get Form’ button to access the CMS-855A application and open it in your editor.
2. Begin by reviewing page 1 to confirm this is the correct application for your needs. Identify if your organization fits into the required categories outlined on that page.
3. Fill out Section 1, Basic Information, by indicating your reason for submitting this application, such as enrolling for the first time or changing ownership.
4. Complete Section 2, Identifying Information, including the provider type, legal business name, Tax Identification Number (TIN), and National Provider Identifier (NPI). Ensure all entries match the records held by the IRS.
5. Provide accurate billing information in Section 2B and confirm that you have the required licenses and certifications relevant to your provider type in Section 2C.
6. Address any changes to your practice location in Section 4. Complete any necessary sub-sections for all relevant practice sites.
7. If applicable, provide details about ownership interests in Section 5. Ensure all individuals and organizations with relevant interests are reported.
8. Carefully fill Section 6 for individuals who have ownership or control over the provider. Include any managing employees or governing body members.
9. After reviewing Sections 3, 10, and 12 for any adverse legal actions or special requirements specific to your Medicaid status, finalize your information.
10. Sign and date the Certification Statement in Section 15, ensuring to acknowledge the penalties for providing false information.
11. Attach all required supporting documentation as listed in Section 17. Ensure that all attachments are relevant to your application.
12. Once completed, review the entire application for accuracy before submitting. You can save changes, download, print, or share the form based on your needs.

Start filling out the CMS-855A online today to streamline your Medicare enrollment process.