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MEDICARE ENROLLMENT APPLICATION

MEDICARE ENROLLMENT APPLICATION . Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers CMS-855S. SEE PAGE 1 FOR A LIST OF THE DMEPOS SUPPLIER STANDARDS. TO ENROLL IN THE MEDICARE . PROGRAM AND BE ELIGIBLE TO SUBMIT CLAIMS AND RECEIVE PAYMENTS, EVERY DMEPOS SUPPLIER. APPLICANT MUST MEET AND MAINTAIN THESE ENROLLMENT STANDARDS. SEE PAGE 2 TO DETERMINE IF YOU ARE COMPLETING THE CORRECT APPLICATION . SEE PAGE 4 FOR INFORMATION ON WHERE TO MAIL THIS APPLICATION . SEE SECTION 12 FOR A LIST OF SUPPORTING DOCUMENTATION TO BE SUBMITTED WITH THIS. APPLICATION . TO VIEW YOUR CURRENT MEDICARE ENROLLMENT RECORD GO TO: Form Approved DEPARTMENT OF HEALTH AND HUMAN SERVICES OMB No. 0938-1056. CENTERS FOR MEDICARE & MEDICAID SERVICES Expires: 05/19. DMEPOS SUPPLIER STANDARDS FOR MEDICARE ENROLLMENT . Below is an abbreviated summary of the standards every MEDICARE DMEPOS supplier must meet in order to obtain and retain their billing privileges.

cms-855s see page 1 for a list of the dmepos supplier standards. to enroll in the medicare program and be eligible to submit claims and receive payments, every dmepos supplier

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