Part B Forms
Welcome to the Part B forms section. As forms are identified and updated for Part B, we will post them to this section.
The forms offered below are in Adobe PDF format. Download a free copy of Acrobat Reader.
General Part B
- All CMS Forms
- IDE Request Requirements
- Immediate Offset Request Form
- Overpayment Refund
- Progressive Corrective Action Form
- Publications Order Form
- PWK Fax/Mail Cover Sheet
- Overpayment Recovery Form
Appeals
Extended Repayment Plan (ERP)
Reopenings
Provider Enrollment
- Enrollment
Applications
- Authorization
Agreement For Electronic Funds Transfer
- Participation
Agreement
Electronic Data Interchange
Effective 09/01/2011, all EDI forms and correspondence must be submitted to the address and/or fax number below for processing. This includes forms for new setups as well as forms for changes to existing setups. Failure to send the forms to the correct address will result in the application being returned to you.
| Address: J15 — Part B Correspondence CGS Administrators, LLC PO Box 20018 Nashville, TN 37202 |
Fax: 615-664-5917 (preferred method for all EDI Correspondence) |
