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Click ‘Get Form’ to open the cms 1728 94 in our platform's editor.
Begin by entering the Provider CCN and the reporting period at the top of the form. Ensure these details are accurate as they are crucial for processing.
In Part I, Certification, check the appropriate box indicating whether the report is electronically filed or manually submitted. Fill in the date and time of submission.
Proceed to fill out Part II, Settlement Summary. Enter relevant data for Title XVIII and Title XIX services, ensuring all figures align with your records.
Complete each section methodically, referring to instructions provided within the form for specific fields like depreciation and service costs.
Once all sections are filled, review your entries for accuracy. Use our platform’s tools to highlight any errors or missing information before finalizing.
Finally, save your completed form and choose to either print it directly or share it via email for further processing.

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