This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations.
This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations.
View this HRSA COVID-19 attestation.
This form is used by Medicare Part A providers for accelerated payments.
PC Print version 9.3.2 is available for download. Please refer to the manual for installation instructions.