Medicare Home DME MAC Jurisdiction C Home Health & Hospice Kentucky Part B Ohio Part B Kentucky & Ohio Part A
Skip Navigation

Send this page to a colleague

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


Extended Repayment Plan (ERP)


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)

An ISO 9001:2008 certified company

CGS Administrators, LLC Home | Site Maps | About Us | Disclaimer | Web Site Feedback | Contact Us

Centers for Medicare & Medicaid Services