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Posting Date: 06/11/2019
Ordering/Referring Provider Only
Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]
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Posting Date: 09/25/2023
Adding a New Reassignment of Benefits Using the CMS-855I
Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]
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Posting Date: 06/11/2019
Electronic Funds Transfer Agreement
Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]
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Posting Date: 04/29/2021
Medicare Participating Physician or Supplier Agreement
Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]
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