CAHPS Hospice Sign Up

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Primary Contact Name:

Enter your first and last name

(First and Last)

Primary Contact Title:

Enter your title

NPI:

Enter a valid 10-digit NPI number

(10 digits)

What is a CCN?

The CMS Certification Number (CCN) is assigned to an agency to verify that a provider has been Medicare certified and for what type of services. The CCN was previously known as the Medicare/Medicaid Provider Number or the Online Survey, Certification and Reporting (OSCAR) Number and is sometimes called the billing number.

The CCN is required to complete the registration process. The CCN is a 6-digit number/character combination.

The CCN is different from the National Provider Identifier (NPI), but the two numbers are linked. The NPI is assigned to covered health care providers and is used for HIPAA standard transactions. Your agency’s billing department can be a helpful resource in identifying the CCN.

CMS Certification Number (CCN):

Enter a valid 6-character CCN number

(CCN - 6 digits/letters )

Agency Name:

Enter the name of your agency

Number Offices:

Enter a valid number

(The total number of hospice offices operating within this Hospice Agency. These are separate administrative or practice offices for the agency, not to be confused with individual facilities or settings in which hospice care is provided. )

Primary Contact Phone:

Invalid phone. Example: 513-555-5555

Ext:

Fax Number:

Invalid fax. Example: 513-555-5555

Primary Contact Email:

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Decedent Sample Start Year:

Decedent Sample Start Month:

Select the month you would like to start

Approximately how many decedents did you have for last year?:

Enter a valid number

Software Company:

Select your software company

(The software that will produce your decedents report)

Data Collection Mode:

Select the data collection mode

REMINDER
Mail mode is available in English and Spanish.

How did you hear about us:

Comments:

Promo Code:

Setup Fee:

Billing Address

Address:

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Address 2:

City:

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State:

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Zip:

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If you have any questions please contact the Fields Research CAHPS Hospice Team at (513) 821-6266