Medicare Part A PWK fax/mail/esMD coversheet 
-- Use this form for voluntary submission of supporting documentation with a version 5010 electronic claim - required for forms received on and after April 1, 2018. Avoid processing issues: Submitting the correct form is important -- Use the correct form today to avoid processing issues.EDI forms -- find the EDI forms you need to begin electronic submissions of claims as well as an electronic data request form to apply for or revise existing information pertaining to the Electronic Remittance Advice (ERA) and/or Electronic Claim Status (ECS) transactions.
Extended repayment schedule for a corporation or group form -- this document is required to consider an extended repayment schedule request for a corporation or group. Extended repayment schedule for sole proprietor form -- this document is required for sole proprietors who wish to request an extended repayment schedule.Request for immediate offset -- use this interactive form when requesting immediate offset of overpayments. CAAP debt dispute request -- use this form for COVID-19 Accelerated and Advance Payment (CAAP) Debt Dispute overpayments.PARD forms -- find the forms you need to submit interim rate and periodic interim payment (PIP) requests as well as statistical and reimbursement report fax sheets.Prior authorization request (PAR) for repetitive scheduled non-emergent ambulance transports (RSNAT) Medicare Part B fax/mail coversheet -- The supplier must submit the PAR before the service is provided to the beneficiary and before the claim is submitted for processing Learn more about the overall PAR RSNAT process.PAR hospital outpatient procedures Medicare Part A fax/mail coversheet -- The hospital outpatient department (OPD), or provider on behalf of the hospital OPD, must submit the PAR for certain hosptial OPD services. Learn more about the overall PAR OPD process.PAR hospital outpatient procedures Medicare Part A expedited fax/mail coversheet Note: This form should only be submitted if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. Provider Enrollment forms -- Learn which forms meet your enrollment needs and how to submit them. Find links to required enrollment applications (CMS-855), Participating physician or supplier agreement (CMS-460), and Electronic file transfer (EFT) applications (CMS-588).CMS’ Beneficiary Notices Initiative (BNI) -- links to commonly used beneficiary notices such as ABNs, FFS and HINNs.
