| Agency Information |
 |
| Status |
Active
checked>
Inactive
checked> |
| Agency Login Code |
#getA.Agency_Login# |
| Agency Name |
|
| Address 1 |
|
| Address 2 |
|
| City |
|
| State |
|
| TimeZone |
|
| Zip |
|
| Contact |
|
| Contact Phone |
|
| Fax |
|
| Contact Email |
|
| Agency Medicare ID |
|
| Agency Medicaid ID |
|
| Wage Index |
|
| National Provider ID |
|
| OASIS Submitter ID |
|
| Hospice Medicare Provider Number |
|
| Hospice Medicare NPI Number |
|
| SFW ID |
|
| Hospice Medicaid Provider Number |
|
| Hospice Medicaid NPI |
|
| Branch State |
|
| Branch ID |
|
| Coding |
Yes
checked>
No
checked> |
Start of Care |
Yes checked>
No checked>
|
Resumption |
Yes checked>
No checked>
|
Recertification |
Yes checked>
No checked>
|
| Faxing? |
Yes
checked>
No
checked> |
| OASIS QA |
Yes
checked>
No
checked> |
| Billing Services? |
Yes
checked>
No
checked>
|
| Meds Data Entry? |
Yes
checked>
No
checked>
|
| Eligibility verification? |
Yes checked>
No checked>
|
| Authorizations |
Yes checked>
No checked>
|
| Intake Data Entry ? |
Yes
checked>
No
checked>
|
| Admission QA? |
Yes
checked>
No
checked> |
| H&P Review? |
Yes
checked>
No
checked> |
| Dataset transmission? |
Yes
checked>
No
checked> |
| CAHPS submission? |
Yes
checked>
No
checked> |
|
| Agent Information |
|
| Agent FEIN |
|
|
|