Cms 460 Participation Agreement Form

Effective Date Enter the date the CMS-460 is delivered or sent to Medicare support or a/B MAC. The start of the contract is the date on which you send your participation agreement to the Medicare institution or a/B MAC. Date This section requires the date the agreement was signed. To enter into a Medicare Participating Physician or Supplier Agreement (CMS-460) Upon receipt of a new Medicare Provider Number, a new Medicare provider has 90 days to submit a Medicare Participating Physician or Supplier Agreement (CMS-460) to Medicare-Carrier or A/B MAC. A participating provider enters into an agreement to accept the amount authorized by Medicare as full payment for Part B services and deliveries. This agreement (CMS-460) is automatically renewed every year. Exception: a change in the name and/or UN (tax identification number) is a change of identity and requires a new decision to participate. If your new provider number has not been established, enter your tax ID or social security number. JJ Part BJM Part B Palmetto GBA Part B Palmetto GBA P.O. Box 100306 Columbia, SC 29202-3306 Palmetto GBA Part B Palmetto GBA Mail Code: AG-310 P.O. Box 100190 Columbia, SC 29202-3190 We regularly update our articles to reflect the latest changes and updates to Medicare and strongly recommend that you visit this article on the link below to confirm that you have the latest version. .

Title This section requires the title of the supplier (M.D., etc.) or representative. . He did not answer my question This article was helpful. . Office phone number In this section, the practice phone number is required… Received up to the effective date, initials of the official carrier This section is completed by the carrier Medicare or A/B MAC….