US · guidance
CMS Pub. 100-06, ch. 6, § 40.1
Heading
A3-3895.1
The intermediary enters the contractor’s assigned 5-digit ID and the PRO's 5-digit ID
number in the indicated spaces. It shows the 2-digit State abbreviation. For the total
page show "Total" in the PRO space. In the space labeled "Report Month/Year" enter the
calendar month and year reported, e.g., show 0692 for June 1992.
History
(Rev. 6, 08-30-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8530a0268563690559e04fe71f0ae3ca730e78c62f0204cb8bde6fc259ee5abe
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