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When a provider is due for revalidation, what do they need to submit?
Last updated Feb 13 2020
Jurisdictions:

The provider(s) will need to submit all sections of the 855A application except sections 2G, 2F, & 2H. Please also include a separate section 5 & 6 for all Ownership/Managing control organizations and individuals. The provider(s) will also need to submit all supporting documentation including: IRS CP 575, NPI notification(s), CMS Form 588 EFT, voided check, or letter from the bank (letter must cite the bank account name, account number, routing number and account type. The bank letter must be on the financial institution letterhead and be signed by a bank officer) with the authorized signers & titles on the account, Licenses & Certifications, Articles of incorporation/organization, and home office chain listing (if applicable).