Medicare Secondary Payer (MSP)

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Top Claim Errors

About Appeals

Levels of Appeals and Time Limits for Filing

Reopenings for Minor Errors and Omissions

CMS Contact

Centers for Medicare & Medicaid ServicesTo offer comments to CMS on the performance of the MAC servicing your state/region, contact CMS at:Jurisdiction 6: OPOLE_IFM_CHIKCGP@cms.hhs.govJurisdiction K: OPOLE_IFM_NY@cms.hhs.gov

Administrative Simplification Compliance Act Waiver Request Form

Advance Beneficiary Notice of Noncoverage (CMS-R-131)

Appointment of Representative Form (CMS-1696)

Clerical Error/Omission Reopening Request Form

CMS -1561 Health Insurance Benefit Agreement

CMS Hospital Cost Report Forms and Instructions

CMS-20134 Medicare Enrollment Application - Medicare Diabetes Prevention Program Suppliers

CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement

CMS-855A Medicare Enrollment Application - Institutional Providers

CMS-855B Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers

CMS-855I Medicare Enrollment Application - Physicians and Non-Physician Practitioners

CMS-855O Medicare Enrollment Application - For Eligible Ordering and Referring Physicians and Non-Physician Practitioners

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