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What to Know About Your Facility’s Security Administrators (SA)

Completing Facility Security Administrator QualityNet Identity Provisioning System (QIPS) Registration Form. What to Know About Your Facility’s Security Administrators (SA) . To utilize CROWNWeb (CW) each facility must designate: a Facility Security Administrator (SA) a Backup SA.

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What to Know About Your Facility’s Security Administrators (SA)

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  1. Completing Facility Security Administrator QualityNet Identity Provisioning System (QIPS) Registration Form

  2. What to Know About Your Facility’s Security Administrators (SA) • To utilize CROWNWeb (CW) each facility must designate: • a Facility Security Administrator (SA) • a Backup SA. • SA’s role: • create and update users • reset passwords • disabling users • Submit user forms for activation • An SA can also serve as a facility editor and do data entry. • A person can only be an SA for one facility. However, an individual can be a user at more than one facility (scope). • A facility may have any number of user/editors or persons with only viewing rights. Every person accessing CW must apply for a QIPS account, but does not require administrative rights.

  3. Getting Started Where to get the QIPS form: https://www.qualitynet.org/crown/registration_form.pdf

  4. Completing the formRequests, Roles, and Dates • Type of Request • Check Create new user account • QIPS Role • Check the Security Administrator • Date Request • The QIPS/ID section is for existing users only (leave blank)

  5. Personal Information Section • Things that need to be completed: (All field with asterisks *) • First and Last Name • Personal address, City, State, Zip Code • Birth date • Fields without asterisks are optional.

  6. Identification Information • (All field with asterisks (*) are Mandatory!) • Provide one of the following forms of identification: • (be sure to note which type of ID is used on form) • Driver’ License • State issued ID card • Passport, • Permanent Resident Card • ID Number specific to the ID • State and Country where ID was issued • Expiration Date of ID provided

  7. Business Information • Applicant email addresss • Phone Number with extension • City, State, Zip Code • Manager’s Email • Manager’s phone number and extension • Business FULL Name • Not just the corporate identifier, the complete facility name • Applicant Job Title • Business Physical address (must match facility name listed above) • Applicant Manager’s Name • Manager’s Job Title

  8. Required Signatures and Notary Involvement • (All field with asterisks (*) are Mandatory!) • Applicant and Manager • Applicant Signature and date • Managers Signature and date (NOTE: Manager must sign page 2 also) • Notarization of Applicants’ Identity • Notary Signature Date • Notary Seal/Stamp • Notary expiration date (DO NOT LEAVE BLANK: use “None” or “At Death” if Notary Certification does not expire) • Notary Signature

  9. Selecting CW Roles and Scope • (All field with asterisks (*) are Mandatory!) • Select “Dialysis Facility” column • Medicare Provider Number: must match the Business name and address put on page 1. Medicare Provider (CNN)numbers start with: • AR=04, LA=19, OK=37 (Do Not use Internal Corporate Number) • ESRD Network Affiliation is 13 • For SA must select “Facility Administrator” role • Other Roles may also be selected (Discuss with your manager)

  10. Additional Scope for Multiple Facilities • (All field with asterisks (*) are Mandatory!) • Use this section only if you work at multiple facilities and need access to edit or view data in CROWNWeb at those facilities. (NOTE: include only NW 13 Facilities on this form) • NOTE: You can only be the SA for ONE facility: for additional facilities you can only select the Edit and/or View roles. • Make sure your manager signs and dates this page(as well as page 1.)

  11. FINAL STEPS • The applicant for SA will send their completed and notarized QIPS forms to Network 13, certified and return receipt requested, via US Mail to the following address: • ESRD Network 13 • Attn: Sean Rosales • 4200 Perimeter Center Drive Suite 102 • Oklahoma, OK 73112-2314 • NETWORK 13QIPS Contacts: • Sean Rosales : 405.948.2259 • Cindy Smith: 405.948.2240 • Nellie Hedrick: 405.948.2253

  12. What Happens Next? • The Network SA will enter the form into the QIPS system: • If missing information, the Network SA will contact the applicant to obtain information . • If information is incorrect or missing information is original signature and/or notarization, the Network SA will notify the applicant that a new form is required. • If form is complete, it will be submitted via the QIPS system. A system generated email from QIPS will be automatically sent to the applicant, the manager and the Network SA. • The form will then be sent from the Network , certified and return receipt requested, to CMS Contractor via USPS to the CROWN HelpDesk for activation. • The volume of forms at the Helpdesk determines the time needed for activation.

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