Get Exprs User Enrollment Form

To gain user access to eXPRS providers will need to complete and return the eXPRS User Enrollment Form for PSW/Individual Providers. Exprs state. or. us 503-947-5357 DHS - ITBSU ATTN eXPRS Security User Enrollment 500 Summer St NE E-12 Salem OR 97301 Please remember to keep a copy of the form for your own records. You will receive a confirmation email from info. exprs state. or. us when your user enrollment is completed and your user access to eXPRS has been granted. Please make sure that your email spam filters are set to allow emails from. How to complete the eXPRS User Enrollment Form for DD PSW/Individual In-Home services Providers eXPRS system in order to directly submit claims for payment and view the applicable service authorizations for the clients that you serve as a provider. The Registry is a different system than eXPRS. Instructions for completing the eXPRS User Enrollment Form In the TOP section of the form Indicate by checking the appropriate box which type of enrollment action you are wishing to take o ADD means be added as a user and given permissions to login to eXPRS o MODIFY means you wish to make a change to your current permissions that you have to access eXPRS. o DEACTIVATE means you wish to terminate your user permissions and close your access to eXPRS. For example if you are no longer working as a PSW/individual provider. O Your Provider ID Number the 6 digit number you received from DHS once your provider enrollment and approved to work status was completed. You may have more than one number if you do different types of work. List at least one or all if you wish of the SPD provider numbers you have assigned. o Your Address o Your eXPRS Login if you already have one If you don t just leave this blank. o Your Email Address In the MIDDLE section of the form Check the box in the columns ADD or DEL to delete next to the user permissions you wish to add or delete. O NAME/LOGIN CHANGE means you wish to change your login or user profile name. PSW user enroll form instructions v2 11-6-13 Page 1 of 3 Then move on to Complete the remaining boxes including information on o Your Name o Your Phone Number o Your Job Title such as PSW worker or in-home provider. o Your Provider ID Number the 6 digit number you received from DHS once your provider enrollment and approved to work status was completed. You may have more than one number if you do different types of work. List at least one or all if you wish of the SPD provider numbers you have assigned. o Your Address o Your eXPRS Login if you already have one If you don t just leave this blank. Please note that this enrollment form does not give you access to the Oregon Home Care Commission s provider Registry. o NAME/LOGIN CHANGE means you wish to change your login or user profile name. PSW user enroll form instructions v2 11-6-13 Page 1 of 3 Then move on to Complete the remaining boxes including information on o Your Name o Your Phone Number o Your Job Title such as PSW worker or in-home provider.