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 Omb#0938 0214 Form 1990

1990-2025 Form

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Instructions and help about Omb#0938 0214 Form

Hi everyone. Welcome and thanks for joining me today. My name is Thom Ryan with Provider Outreach and Education at WPS Government Health Administrators. I'll be your presenter for this video. This is an instructional video for how to complete section one of the CMS form 855I for provider enrollment of Physicians and non-physician practitioners. If you're unsure of what the CMS form 855i is, who should complete it, or the basic instructions, we do have a getting started video. Use the info button, in the upper right corner, to access that video before completing this video. To complete section one, move to page four. Section one is your basic information. This is the reason that you are completing the application. The options in Section 1 include: new enrollee, change to the professionals existing Medicare enrollment information, Medicare requested revalidation, reactivation of your Medicare enrollment to build Medicare; last, terminating your Medicare enrol

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