Close
Your Web browser does not support iframes. Please use the "Select a State" option to find a CBA.
CBIC
^ Back to Top
Close Window [x]
Enter a ZIP code and click the OK button:
.
- OR -
Select a state, then a round:
1. Select a State
.
--Please Choose One--
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
MI
MN
MO
MS
NC
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
TN
TX
UT
VA
WA
WI
WV
2. Select a Round
.
3. Select the CBA
.
Close Window [x]
CBIC Site
CBIC Site
Round 1 2017
Round 1 2017
Round 1 Rebid
Round 1 Rebid
Round 1 Recompete
Round 1 Recompete
Round 2 Recompete
Round 2 Recompete
Round 2
Round 2
Contract Suppliers~Forms
CBIC HOME
ABOUT US
CONTACT US
Query:
Bidding Suppliers
Registration
Bidding
Request for Bids (RFB) Instructions
DBidS: Online Bid Submission System
Forms
Required Financial Documents
Bid Preparation Worksheets
Bid Evaluation
Frequently Asked Questions (FAQs)
Bid Evaluation FAQs
Bidding FAQs
Contract Suppliers
Contract Supplier Locations
Subcontracting
Contract Terms and Obligations
Change of Ownership
Payment Policies
Forms
Contract Suppliers FAQs
CHOW FAQs
Contract Supplier Obligations FAQs
Dual Eligibles FAQs
Form C FAQs
Rented DME FAQs
Rented Oxygen FAQs
Repairs and Replacements FAQs
Subcontracting FAQs
Transition FAQs
Competitive Bidding Areas
Round 2~Competitive Bidding Areas
Product Categories
Round 2~Product Categories
Single Payment Amounts
Round 2~Single Payment Amounts
Grandfathering Information
About Grandfathering
Beneficiary Notification Process
Grandfathering FAQs
Grandfathering DME FAQs
Grandfathering Oxygen FAQs
Important Dates
Timeline
Educational Information
Competitive Bidding Liaisons
FAQs
Fact Sheets
Round 2
National Mail-Order
News and Bulletins
Education Events
Terms and Definitions
Quarterly Updates
Round 2~Quarterly Updates
Top Links
Stay Connected
Keep up with the latest information about the DMEPOS Competitive Bidding Program by taking advantage of the Internet's connectivity.
Please Wait...
CBIC
/ Round 2
/ Contract Suppliers / Forms
permaLink
Contract Suppliers
Forms
These forms are no longer available for Round 2 and the national mail-order competition.
Change of Ownership - Contract Supplier Notification Form
Per Article V of the DMEPOS competitive bidding contract and §414.422(d)(1), a contract supplier is obligated to notify CMS at least 60 calendar days before the anticipated date of a change of ownership (CHOW). Contract suppliers should provide the information contained on this form. Failure to notify CMS may result in a breach of contract. Please refer to the CHOW fact sheet for more detailed information and instructions.
06/30/2016
Change of Ownership - Purchaser Form
Purchasers of contract suppliers may request the transfer of a contract as part of a change of ownership transaction. A Purchaser should provide all information on this form and the required documentation outlined in the Change of Ownership (CHOW) fact sheet at least 30 calendar days before the effective date of the CHOW.
06/30/2016
Contract Supplier Change of Information Form
Contract suppliers may request to change an authorized official to another authorized official on their enrollment file in the Provider Enrollment, Chain, and Ownership System (PECOS) and with the National Supplier Clearinghouse, change an e-mail address or phone number for an AO or BAO, or add/update a toll-free number for the Supplier Directory on the Medicare website.
06/30/2016
Contract Supplier Location Update Form
Contract suppliers may request that locations be added to or removed from their contracts. Additions or removals may be requested at any time. All requests are subject to approval by the Centers for Medicare & Medicaid Services (CMS) and will be processed as quickly as possible after final contract execution.
06/30/2016
Form C
Instructions to complete the quarterly report updating product information posted on the Medicare Supplier Directory.
06/30/2016
Subcontractor Disclosure Form
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires contract suppliers to disclose to CMS information regarding their subcontracting relationships.
06/30/2016
last updated on 06/30/2016
ver 2.0