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Click 'Get Form' to open the CMS-855I in our platform's editor.
Begin with Section 1, where you will indicate the 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.
Proceed to Section 3 to report any final adverse legal actions. Fill this section completely as it is crucial for your application.
Complete Section 4 with your business information if applicable. If you have multiple practice locations, ensure each is reported accurately.
Review all sections for accuracy and completeness before signing in Section 15. Use our platform’s tools to easily edit or add any necessary information.
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mportant Information for CAHs Billing under Method II
Sep 7, 2025 CMS-855I. Starting in January 2026, CMS will deny CAH claims for professional services if a reassignment is not in PECOS. As of July 2025Read more
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