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Printed Date: 9/22/2015
If the billing privileges are inactivated for any reason, the CMS 855S must be completed in its entirety. All attachments (e.g., licenses, insurance, IRS documents, copy of the NPI notification) must be included. The CMS 855S (PDF, 609 KB) may be downloaded from the CMS website or suppliers may submit the application electronically through the Provider Enrollment Chain and Ownership System (PECOS).
Note: Billing privileges will not be reactivated until the entire process is completed and the supplier has been determined to be in compliance with the supplier standards. It is in the best interest of the supplier to keep on top of revalidation, etc., to make sure that its billing privileges are not deactivated. Claims cannot be paid during the time billing privileges are inactive.
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Last Updated: 03/13/2018