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- Click ‘Get Form’ to open the cms855i form in the editor.
- Begin with Section 1, where you will indicate your reason for submitting the application. Check the appropriate box and complete all applicable sections.
- In Section 2, provide your personal identifying information. Ensure that your name, date of birth, and Social Security Number match your official records.
- Move to Section 3 to report any final adverse legal actions. This section must be filled out completely if applicable.
- Complete Section 4 by providing business information if you have a private practice. Include details about your practice location and any billing agency information in subsequent subsections.
- Finally, review all sections for accuracy before signing in Section 15. Your signature certifies that all information is true and complete.
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