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How to prepare CMS-855A Form

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How to complete a 855a?

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FAQ - CMS-855A Form

What is the purpose of CMS-855A Form?
The purpose of CMS-855A is to identify the person responsible for the payment of the claim. If the payment is made by an electronic fund transfer, CMS-855A Form will also allow you to enter an address and/or a telephone number of the recipient or payee of the claim. When should I submit my claim? The primary source of the claim and your claim number: Must be submitted to the Internal Revenue Service Office of Claims Operations (OI-CSA) by the last day of the month following the month in which the payment was made. Do not attempt to submit your claim if it's been more than 30 days since the last payment was made. Must be submitted by the last day of the month following the month in which the payment was made. If the payment was not made to you personally and/or you're not the named payee (either because you're not identified on the invoice or because it's not your invoice), then you must submit your claim by the last day of the following month. If you think that you or someone else can be the payee of your payment in the month of your claim, submit your claim early and don't wait until the end of the month to submit your claim. If your claim is submitted after the 60-day “catch-up” period for payment, or you submit a claim after it's due (but after you've received the form), you have 60 days and five business days to file the claim (if you don't, the IRS may return the payment to you). If you file your claim after the period, you may be subject to liability on it, such as interest and penalties.
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