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To opt-out, eligible practitioners must submit an opt-out affidavit. View this sample form. 

Section 4507 of the 1997 Balanced Budget Act allows a physician or practitioner to enter a private contract with a Medicare beneficiary.

The CMS sample revalidation letter offers providers the opportunity to see what they can expect to receive when it is time for them to revalidate. Access the revalidation request letter to be prepared for your revalidation.

The CMS sample revalidation letter offers providers the opportunity to see what they can expect to receive when it is time for them to revalidate. Access the stopping billing privileges letter to be prepared for your revalidation.

Use this questionnaire for assistance in determining if the referring laboratory may bill for tests performed by a reference laboratory.

Participants agree to accept assignment for all covered services provided to Medicare patients. New physicians, practitioners, and suppliers may submit this form at the time of enrollment.

This interactive “Electronic Data Interchange (EDI) enrollment form” is intended for provider use only.

This form is for third-party agents such as clearinghouses and billing services to enroll for electronic transactions.

Use this form for voluntary submission of supporting documentation with a version 5010 electronic claim. This is NOT an EDI enrollment form.