Get Qies Mdsepocpbj Corporate Access Request - Qtsocom

The QIES MDSePOCPBJ Corporate Access Request form is essential for designating corporate users who can submit assessments and staffing information on behalf of facilities. Properly completing this form ensures seamless access to necessary data and management functionalities.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the QIES MDSePOCPBJ Corporate Access Request form and open it in your preferred form editor.
2. Begin filling out the Type of User Request section. Indicate whether you are requesting to create a new corporate personal user ID or changing access to existing facilities.
3. In the Corporate User Information section, provide the required details such as the first and last name, phone number, email address, corporation name, and physical address of the corporation.
4. Include the corporate contact's name, title, phone number, and their signature in the relevant fields. Make sure the request date is also filled out.
5. In the Section for Reason for Additional Facility Access, provide a brief justification explaining why additional user access is needed.
6. Next, complete the Facility Information section. List all facilities you wish to add or remove for the corporate user's access. For state license-only facilities, include the Facility IDs instead of Medicare CCNs.
7. After ensuring all information is accurate and complete, review the form. Save your changes, and print the document for your records.
8. Submit the signed form via fax or email to the QTSO Help Desk. Remember, emailed submissions must include provider letterhead as an attachment, and fax submissions should come from the corporate fax machine.
9. If you do not receive an email acknowledgment within two business days after submission, contact the help desk immediately. Allow five business days for processing.

Complete your QIES MDSePOCPBJ Corporate Access Request online today!