Form CMS-10495 Review and Dispute Screen Shots
Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)
CMS-10495 - Review And Dispute Screen Shots 9.23.2020 - 508 cf
Dispute and Resolution Correction (Teaching Hospitals)
OMB: 0938-1237
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1237 can be found here: