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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

Appeals

Extended Repayment Plan (ERP)

Reopenings

Provider Enrollment

Electronic Data Interchange

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: Fax:
J15 — Part B Correspondence
CGS Administrators, LLC
PO Box 20018
Nashville, TN 37202
FAX: 615.664.5927 (preferred method for all EDI Correspondance)


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Centers for Medicare & Medicaid Services