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Practice Manager Form

Medicare Participation Agreement (CMS-460)

A downloadable Practice Manager form for healthcare professionals.
Auto-fill with HeidiBrowse templates

Specialty

Practice Manager

Downloads

2 times

Type

Form

Last edited

26/01/2026

Created by

Heidi Team

Auto-fill with Heidi

About this form

The Medicare Participation Agreement (CMS-460) is used to enroll as participating providers in Medicare Part B. By signing this agreement, the provider agrees to accept assignment for all covered Part B services, meaning Medicare-approved amounts are accepted as full payment, subject only to applicable deductibles and coinsurance. The form captures provider or supplier identifiers, National Provider Identifier (NPI), and agreement details required to establish or maintain Medicare participation. Completing this form in Heidi streamlines your administrative processes and assists practices in managing Medicare participation records.

Preview form

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How to use this form

1

Auto-fill with Heidi

Click "Auto-fill Form with Heidi" to open the form in Heidi and complete the fields straight from your note, no copying and pasting.

2

Review and edit

Check the pre-filled details and make any changes before finalising the form.

3

Download or save

Download the completed form or save it directly into your patient records and workflows.

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