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 What Needs to Be Filled Out on an Cms 855o Application Form 2013

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Instructions and help about What Needs To Be Filled Out On An Cms 855o Application Form

Hi everyone and thank you for taking the time to watch this video today. My name is Thom Ryan with Provider Outreach and Education at WPS Government Health Administrators. This video covers completing section two, item A on the form CMS 855O. The purpose of the form CMS 855O is for professionals to enroll in Medicare to order or refer services. Enrolling with this form does not allow the professional to bill Medicare for their services. To complete section two, item A, move to the bottom of page three. Item A is for the personal information in the provider enrollment record. This information must be completed regardless of the action you are taking with the 855O. Section two has items B and C. The instructions for these two sections  are in another video as not everyone needs to complete them. To begin completing item A, enter the name fields.    There are three fields, and the first one is the required field. On the first row, complete the person's legal name. Th

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