Provider Enrollment Handout - Palmetto GBA
Provider Enrollment Handout - Palmetto GBA
Provider Enrollment Handout - Palmetto GBA
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CMS <strong>Provider</strong> <strong>Enrollment</strong> Forms CMS 855I CMS 855B CMS 855R CMS 460 - Participation Agreement CMS 588 - Electronic Funds Transfer(EFT) AgreementSpeaker Note: These forms can be found in the <strong>Provider</strong> <strong>Enrollment</strong> section of the CMSand <strong>Palmetto</strong> <strong>GBA</strong> Web sites. Downloading directly from the Web ensures you are usingthe most current form available.PTANs and NPIs <strong>Provider</strong> Transaction Access Number(PTAN) Minimum number of PTANs will beassigned Exceptions are made for hospitaldepartments under certaincircumstances National <strong>Provider</strong> Identifier (NPI)Speaker Note: To obtain an NPI providers should use the Web based National Plan and <strong>Provider</strong>Enumeration System also known as NPPES. To access this site, go to the CMS web page.4
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