3/13/2008 How to Complete the Medicare CMS-855B Enrollment Application Navigation Presented by

Transcription

3/13/2008
1
2
How to Complete the Medicare CMS-855B Enrollment Application
Presented by
Provider Outreach & Education
and
Provider Enrollment
Navigation
This CBT is made up of a collection of slides. Use the navigation buttons located at the bottom of each slide to
navigate through this CBT.
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Welcome
Revised CMS-855B
Is this the correct form for you?
Do you have the CMS-855B form?
Provider Enrollment Hotline
Significant Changes
Have you applied for your National Provider Identifier (NPI)?
Electronic Funds Transfer (EFT)
Did you know you may not have to complete the entire application?
Section 1A: Basic Information
Section 1B: Basic Information
Section 1: Attachments 1 and 2
Section 2: Identifying Information
Section 2B2: Identifying Information
Section 2C: Identifying Information
Section 2D: - Identifying Information
Section 2F: Identifying Information
Section 3: Adverse Legal Actions
Section 4: Practice Location Information
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Section 5: Ownership Interest Organizations
Section 6: Ownership Interest
Individuals
Individuals
Section 8: Billing Agency
Section 13: Contact Person
Section 14: Penalties for Falsifying Information
Section 15: Certification Statement
Section 16: Delegated Official
Section 17: Supporting Documents
Attachment 1 – Ambulance Suppliers
Attachment 2: Independent Diagnostic Testing Facility (IDTF)
Prescreening
Prescreening – Missing Information
Rejected vs. Returned
Criteria For Returned Applications
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No signature on application.
Old version of application submitted.
Copied or stamped signature.
CMS-855I signed by someone other than individual practitioner applying for enrollment.
Applicant failed to submit all forms needed to process a reassignment package.
Completed application in pencil.
Wrong application submitted.
Web-generated application submitted but does not appear to have been downloaded off CMS' Web site.
Application not mailed (i.e., it was faxed or e-mailed).
1

2
Application received more than 30-days prior to the effective date listed on the application. (This does not apply to
certified providers, ASCs or portable X-ray suppliers.)
Provider submitted new enrollment application prior to expiration of time in which provider is entitled to appeal the
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3/13/2008
denial of his previously submitted application.
Submitted CMS-855 for sole purpose of enrolling in Medicaid.
CMS-855 not needed for the transaction in question.
CMS-588 sent in as a stand-alone change of information request (i.e., it was not accompanied by a CMS-855) but was
1) unsigned, 2) undated, or 3) contained copied, stamped or faxed signature.
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Most Common Reasons for Delays
Application Processing
Reminders
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Thank you for participating in this Computer-Based Training
Provider Enrollment
and
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3/13/2008
Publish Date:6/28/2007
Navigation
How to Complete the Medicare CMSCMS-855B
Enrollment Application
This CBT is made up of a collection of slides. Use
the navigation buttons located at the bottom of
each slide to navigate through this CBT.
Presented by
and
Provider Enrollment
Slide 1 Out of 58
Slide 2 Out of 58
Welcome
Welcome to the Computer-Based Training (CBT) module for
Provider Enrollment.
This presentation was developed by the Provider Outreach &
Education department along with the Provider Enrollment
department in an attempt to assist you with correctly
completing the CMS-855B enrollment form the first time.
Slide 3 Out of 58
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3/13/2008
Revised CMSCMS-855B
On May 1, 2006, the Centers for Medicare & Medicaid Services
(CMS) released and implemented a new version of the
CMS-855 Medicare enrollment applications (versions 04/06
and 06/06).
The appearance and format of the enrollment applications
were revised to help providers accurately complete the
applications. Revisions included:
• Larger font and plain language.
• Tips on how to avoid delays.
• Updated instructions to help you know which application to
submit.
• Redesigned Section 17.
Slide 4 Out of 58
Is this the correct form for you?
Do you have the CMSCMS-855B form?
The CMS-855B form is used by the following:
• Ambulance service supplier.
• Ambulatory surgical center.
• Clinic/group practice.
• Competitive Acquisition Program (CAP) Part B drug vendor.
• Independent clinical laboratory.
• Independent diagnostic testing facility.
• Mammography center.
• Mass immunization (roster biller only).
• Portable X-ray supplier.
• Radiation therapy center.
• Slide preparation facility.
• Voluntary health/charitable agency.
Slide 5 Out of 58
If you do not have a copy of the
form, please take a few minutes
to print it. You will use it
as a guide throughout
this presentation.
The form is located on
the CMS Web site at:
www.cms.hhs.gov/cmsforms/downloads/cms855b.pdf
Slide 6 Out of 58
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Provider Enrollment Hotline
Significant Changes
Have you applied for your National Provider Identifier
(NPI)?
If after completing the CBT you still have questions, contact
the Provider Enrollment department for your area:
Providers are required to submit the new version of the
enrollment form and additional information with all initial
enrollment applications and changes of information .
As a Medicare health provider, you must obtain an NPI prior to enrolling in
Medicare or before submitting a change of existing enrollment information.
The NPI notification must be submitted with the enrollment form.
• Texas and Indian Health facilities:
((866)) 528-1602.
Required additional information includes:
NPI was mandated by the Health Insurance Portability and Accountability
Act
Act.
• The NPI notification (if it was not previously submitted with
an application that was processed completely).
• Completed CMS-588 form (Electronic Funds Transfer (EFT)).
• All required documentation necessary to process the
enrollment form.
• Virginia:
(866) 697-9670.
• DC/Delaware/Maryland:
(866) 828-6254.
NPI is a 10-digit number that will replace current Medicare identifiers. The
NPI will not change and will remain with the provider regardless of job and
location changes.
Effective May 23, 2007, all Medicare claims must be submitted with only
the NPI.
The Web site of the NPI Enumerator is:
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Slide 7 Out of 58
Slide 8 Out of 58
Slide 9 Out of 58
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Electronic Funds Transfer (EFT)
EFT is a way for Medicare to pay providers with a money
transfer directly into a bank account. This eliminates the need
for a provider to wait for a check to be mailed.
CMS requires that providers filing a CMS-855 form have EFT.
The application is to be included with the enrollment form.
The EFT form, CMS-588, is located at:
www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf
Slide 10 Out of 58
Section 1A: Basic Information
Did you know you may not have to complete the
entire application?
Not every circumstance requires the CMS-855B to be
completed in its entirety. Those include:
• Voluntarily terminating Medicare enrollment.
• Changing information:
o Identifying information.
o Adverse legal actions.
o Practice location, payment address or record storage.
o Ownership interest and/or managing control.
o Billing agency information.
o Authorized official.
o Delegated official.
This CBT will now review each section of the CMS-855B form.
Slide 11 Out of 58
Complete the form in blue or black ink.
DO NOT USE PENCIL.
This section captures
information about why you
are completing the
application. It also provides
a list of required sections
pertaining
p
g to your
y
reason.
√
Find the section that applies
to you. Only one reason
per application should be
checked.
Select this checkbox If you are
changing your Medicare
Identification Number or NPI
information.
(Page 4)
Slide 12 Out of 58
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If you are reporting a
change to your Medicare
enrollment information,
you will need to complete
Section 1B. Check all
areas that are being
revised
revised.
Section 1B: Basic Information
Section 1: Attachments 1 and 2
Read and follow each
section requirement for
the change(s) you've
selected.
Section 2 is for information
about the provider. It identifies
the type, name, address and
information for specific
suppliers.
Ambulance Suppliers and
Independent Diagnostic Testing
Facilities (IDTF) must complete
the appropriate sections on
Page 6 if they are reporting
changes to their Medicare
enrollment
information.
√
If you do not find your supplier
type under Section 2A,
2A mark
"Other" and write the supplier
type on the line provided.
All other providers can move
on to Section 2.
Not all providers will need to
complete all of Section 2.
√
ABC Health Clinic
123456789
√
If you are an American Indian
and/or an Alaska Native
facilities, see next slide.
Section 6 is also required if
adding a delegated official.
(Page 5)
(Page 6)
Slide 13 Out of 58
(Page 7)
Slide 14 Out of 58
Slide 15 Out of 58
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If you are an American
Indian and/or an Alaska
Native facilities, check the
"Other"
Other boxes in Section
2B. Identify if you are tribe
or Indian Health Services
(IHS) facility.
Section 2B2 identifies any state license or certification
information required for you
to operate as the provider
type for which you are
enrolling.
√
Tribe Name
123456789
Tribal Health Clinic
√
√
Part of Tribe or IHS
Tribe or IHS
If applicable, you must
provide the license or
certification number,
state where issued, and
effective and expiration
dates.
In Section 2B3, list the
correspondence address
for the entity listed in
question 2B1.
√
123 Medical Way
y
Suite 1A
Medical City
√
(123)456-7890
Any ST. 12345-6789
(123)456-7891
[email protected]
You must indicate if a state
license or certification
is not applicable for the type of provider you are enrolling.
(Page 8)
Slide 16 Out of 58
(Page 8)
Slide 17 Out of 58
Slide 18 Out of 58
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Section 2C: Identifying Information
Section 2D: - Identifying Information
Use Section 2D to list any
comments that will help explain
information provided in
Section 2.
Section 2C is only for
hospitals needing a
Medicare Part B billing
number for a specific
department.
Indian Health clinic with no street
address. Located 1 mile east of
county road 121 and highway 40.
Section 2E: - Identifying Information
If your facility does not meet
this criteria, skip to Section
2D.
You have now completed
Section 2, move to Section 3.
(Pages 9 and 10)
(Page 9)
Slide 19 Out of 58
Section 2G: Identifying Information
This section is to report the
termination information of a
physician assistant from your
group/clinic.
Section 2E is for physical
therapy and occupational
therapy groups only. Each
question must be answered
by selecting “Yes” or “No.”
(Pages 8 and 9)
Section 2F: Identifying Information
Section 2F is for free-standing
Ambulatory Surgical Centers
(ASCs). Check either “Yes” or
“No” and complete other
information as required.
Slide 20 Out of 58
Slide 21 Out of 58
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Complete Section 3 for all past
or present legal convictions,
exclusions, revocations and
suspensions regardless of
whether or not the record has
been expunged or an appeal is
pending.
pe
d g A list
s o
of reportable
epo ab e
items is provided on Page 11.
You must answer question
No. 1.
Section 4 must include information
about where the group or
organization provides health care
services. Provide the specific street
address as recorded by the United
States Postal Service. Do not
provide a P.O. Box.
√
If you answer "Yes" to
question No. 1, you must
complete question No. 2.
Section 4 will identify where
medical records are stored, the
address for remittance notices and
special payments.
You have now completed
Section 3, move to Section
4.
(Page 11)
All providers are required to
complete Section 4.
(Page 13)
(Page 12)
Slide 22 Out of 58
Slide 23 Out of 58
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Provide the practice location name used
in everyday operation in Section 4A.
Enter the full street number, city, state
and nine-digit ZIP code. Do not list P.O.
Box numbers. List the telephone number
for the physical location. A fax number or
e-mail address is not necessary.
American Indian and/or Alaska Native
clinics with no street address should list
General Delivery or Main Street as the
address
address.
Enter the first date a Medicare patient
was seen at this location. This does not
have to be the date the location opened
for business.
Enter the Medicare identification number,
if issued, and the NPI for the clinic. Select
the option that best fits this practice
location. If the practice has a CLIA and/or
an FDA certification, enter the numbers
and attach a copy of the certification.
ABC Health Clinic
123 Medical Way
S it 1A
Suite
Medical City
(123)456-7890
01/02/2007
√
Section 4B contains information
about where the group's
remittance notices will be sent.
This address will also be used
to send any special Medicare
payments that are not sent
electronically.
y
Any ST.
(123)456-7891
12345-6789
[email protected]
2468101214
12D345678
(Page 14)
Medicare will issue payments via
Electronic Funds Transfer (EFT).
Since payments will be made via
EFT, the “Special Payments"
address should indicate where
all other payment information
should be sent.
If you store patients'
medical records at a
location other than what
is reported in Section 4A or
4E, complete this section.
If this section is not
completed, you are indicating
that all records are stored at
the practice locations
reported in Section 4A or
4E.
√
(Pages 15 and 16)
(Page 15)
Slide 25 Out of 58
Slide 26 Out of 58
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Complete Section 4D If you
provide services in patients'
homes. If you do not render
services in patient's homes, skip
this section.
If you provide services to an
entire state, enter the state.
You do not need to list each
city/town separately.
In Section 4E, enter the base of
operations information. Enter
the location where personnel
is dispatched, where
mobile/portable equipment is
stored and where vehicles are
parked when not in use.
Dallas
Ft. Worth
Not all providers will need to
complete this section.
Texas
Texas
If you only provide services in a
city/town, enter the city or town’s
name and the state.
The ZIP code is only required
if you are not servicing the
entire city/town.
(Page 17)
Do not report vehicles that are
used to
o transport
a spo medical
ed ca
equipment if services are not
provided in the vehicle.
√
Copy and complete Section 4F
if there are more than two
vehicles to report. Up to two
vehicles can be reported per
form.
If the address for the base of
operations is the same as
Section 4A, check the
Indicated box.
(Page 18)
Slide 28 Out of 58
In Section 4F, list vehicles that
are used to provide medical
services. This does not include
ambulances.
(Page 18)
Slide 29 Out of 58
Slide 30 Out of 58
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Section 5 is for any organization
that owns 5 percent or more of
the provider facility completing
the application. (Section 5 is not
for reporting individuals).
Organizations that have
managing control or partnership
interests must also be listed
listed.
Section 4G is used to report the
rendering location of mobile or
portable services.
Reporting can be by an entire
state or by cities/towns
cities/towns.
Additions and deletions can be
made on the same application.
If Section 5A does not
pertain to your situation
then indicate "Not Applicable."
√
American Indian and/or Alaska
Native organizations must list
the name of the government
(i.e., Indian Health Service) or
tribal organization that will be
legally and financially
responsible.
(Page 20)
(Page 19)
Slide 31 Out of 58
(Page 21)
Slide 32 Out of 58
Slide 33 Out of 58
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If you check change, add or
delete, you must furnish the
effective date.
Section 5B is to report any
adverse legal history of the
controlling organization.
Example of American Indian
and/or Alaska Native information.
Indicate at least one ownership
or managing
g g control category.
g y
√
You must answer question
No. 1.
Refer to Page 11 for a description
of adverse legal actions.
The business name must be
what is reported to the IRS.
√
The Doctors Partnership
ABC Health Clinic
123 Medical Way
Suite 1A
Medical City
246810121
Tribal Name
√
Tribal Health Clinic
123 Native Way
Any ST. 12345-6789
(Page 21)
Indian Country
(Page 21)
Slide 34 Out of 58
Any ST 24680-1214
369121518
(Page 22)
Slide 35 Out of 58
Slide 36 Out of 58
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Individuals
Individuals
If there is more than one individual
Adverse legal actions must be
completed for each individual
reported
reported.
If the provider listed in Section 2
is a corporation,
p
, list all officers and
directors.
American Indian and/or Alaska
Native groups report its managing
employees in Section 6.
List all individuals with partnership
interests regardless of percent
of ownership.
√
01/02/2007
John
111-11-1111
12/25/1950
√
Doe
N/A
N/A
(Page 23)
(Page 24)
Slide 37 Out of 58
A billing agency may perform
other services for you
you, but claims
completion and/or submission
are included in your contract.
If you do not use a billing agency,
you must indicate by checking
the first box.
√
You must check either "Yes" or
"No" in response to question No. 1
in Section 6B.
List all authorized and delegated
officials in this section.
Use Section 8 to report any
individual or entity with whom you
have contracted to prepare and
√
submit claims for the business.
who needs to be reported, copy
and complete this section for each
individual.
Section 5 contains the information
for individuals having ownership
of 5 percent or more of the group.
(Page 25)
Slide 38 Out of 58
Slide 39 Out of 58
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Section 13: Contact Person
The contact person should be
someone who can answer
questions about the information
on the application.
If you check the box indicating
a change, add or delete, you
must furnish the effective date
And complete the appropriate
fields.
987654321
369 Billing Ave.
Claims Town
(369)101-2345
Any St. 78910-2345
(369)101-2346
(Page 25)
Slide 40 Out of 58
If the contact person will be
either the authorized or delegated
office, check the appropriate box
and skip to the indicated section.
There can be more than one
contact person. Copy and
complete this page for each
contact.
(Page 26)
Jane
(123) 456-7890
Section 14: Penalties for Falsifying Information
Section 14 outlines the penalties
for falsifying information and
should be read by the authorized
and delegated officials legally
responsible
ibl for
f the
th provider
id
listed in Section 2.
Medicare will not list the contact
person on the Medicare
provider’s record.
ABC Billing
Doe
(123) 456-7891
This section does not have an
area to be completed.
123 Medical Way
Suite 1A
Medical City
Any ST. 12345-5678
[email protected]
(Pages 27 and 28)
Slide 41 Out of 58
Slide 42 Out of 58
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3/13/2008
Page 29 provides a description of
an authorized official and a
delegated official.
Sections 15B and 15C are for
authorized official(s) only.
Authorized official(s) must sign
this p
page.
g Use blue ink which
will indicate an original signature
and not a copy.
Examples of an authorized official
are chief executive officer
officer, chief
financial officer, general partner,
chairman of the board, or direct
owner. Only an authorized official
has the authority to sign the initial
enrollment application. A delegated
official does not have this authority.
John
(246)810-1214
John Doe, CEO
Doe
CEO
1/2/2007
(Pages 29 and 30)
Slide 43 Out of 58
If no delegated official is appointed,
the authorized office will be
responsible for all changes and
updates made to the provider's
record.
All signatures must be original and
signed in ink. Applications with
signatures deemed not original will
not be processed. Stamped, faxed
or copied signatures will not be
accepted.
All signatures must be original and
signed in ink. Applications with
signatures deemed not original will
not be processed. Stamped, faxed
or copied signatures will not be
accepted.
(Page 31)
The officials must read and
understand Pages 29 and 30.
Section 16: Delegated Official
Section 16 is optional.
Authorized official(s) must also
be listed in Section 6 of this
form.
Authorized officials and delegated
officials must be reported in
Section 6 of this application.
Charlie
Charlie Brown
John Doe, CEO
Brown
(246)810-1214
1/2/2007
1/2/2007
(Pages 32 and 33)
Slide 44 Out of 58
Slide 45 Out of 58
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3/13/2008
Section 17: Supporting Documents
Indicate in Section 17 what is
attached to the application. Check
the corresponding boxes for all
information being attached to
the application.
Attachment 1 – Ambulance Suppliers
Pages 35–37 of Attachment 1
contains information on geographic
location of services, state licensure
information, paramedic intercept
services and vehicle information.
√
√
√
Don't forget:
√
• Tax documents (IRS CP-575).
√
• CMS-588
CMS 588 Electronic
El t i Funds.
F d
√
• NPI notification.
• Copies of any State licenses or
certifications.
• If applicable, copies of CLIA,
√
• FDA and/or Diabetes Program
√
certifications.
• Copy of attestation for government
and tribal organizations.
(Page 34)
Attachment 2: Independent Diagnostic Testing
Facility (IDTF)
IDTFs are to complete Pages
38–44.
On Page 36, Paramedic intercept
service is defined as a basic life
support ambulance providing the
transport, while advance life
support paramedics from another
ambulance supplier provides the
personnel for the transport. You
must check “Yes” or “No.”
An IDTF is required to provide
all codes that are allowed to be
performed equipment and model
performed,
numbers. Information on an
interpreting physician, technicians
who perform tests and supervising
physicians are required.
Copy and complete Page 37 for
each vehicle used by the
ambulance company.
Page 44 requires an original
signature by the supervising
physician.
(Pages 35–37)
Slide 46 Out of 58
(Pages 38–44)
Slide 47 Out of 58
Slide 48 Out of 58
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Prescreening
All applications are prescreened, including changes of
information and reassignments, within 15 calendar days of
receipt.
If an application is received that contains at least one missing
required data element, or the provider fails to submit all
required supporting documentation:
• TrailBlazer will send a letter to the provider (where
appropriate the letter can be sent via e
appropriate,
e-mail
mail or fax)
fax), that
documents and requests the missing information.
• The letter must be sent to the provider within the 15-day
prescreening period.
• TrailBlazer is not required to make any additional requests
for the missing data elements or documentation after the
initial letter.
Prescreening ensures providers submit all required
supporting documentation and a complete enrollment
application.
This process applies to all applications.
Slide 49 Out of 58
Slide 50 Out of 58
The provider must furnish all missing information within 60
calendar days of the request. If the provider fails to do so the
application will be rejected. The provider will be notified by
letter with the reasons for rejection and how to reapply.
reapply If the
provider wishes to reapply he will be required to begin a new
process.
Slide 51 Out of 58
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Rejected vs. Returned

The difference between a rejected and returned application is
that an application is rejected based on the provider's failure
to respond to TrailBlazer's request for missing information
or clarification.
An application is subject to immediate return based on
specific
ifi criteria.
it i All resubmissions
b i i
mustt contain
t i a newly
l signed
i
d
and dated certification statement page.

Slide 52 Out of 58
Criteria For Returned Applications
No signature on application.
Old version of application
submitted.
Copied or stamped signature.
CMS-855I signed by someone
other than individual practitioner
applying for enrollment.
Applicant failed to submit all
forms needed to process a
reassignment package
package.
Completed application in pencil.
Wrong application submitted.
Web-generated application
submitted but does not appear to
have been downloaded off CMS'
Web site.
Application not mailed (i.e., it was
faxed or e-mailed).

Application received more than 30days prior to the effective date listed
on the application. (This does not
apply to certified providers, ASCs or
portable X-ray suppliers.)
Provider submitted new enrollment
application prior to expiration of
time in which provider is entitled to
appeal the denial of his previously
submitted application.
Submitted CMS-855 for sole purpose
of enrolling in Medicaid.
CMS-855 not needed for the
transaction in question.
CMS-588 sent in as a stand-alone
change of information request (i.e., it
was not accompanied by a CMS-855)
but was 1) unsigned, 2) undated, or
3) contained copied, stamped or
faxed signature.
Slide 53 Out of 58
Most Common Reasons for Delays
TrailBlazer is allowed to reject for missing information. The top
reasons for rejections that we see in our Provider Enrollment
area are:
• Missing NPI notification.
• Missing
g CMS-588 – Authorization Agreement
g
for
Electronic Funds Transfer.
• Failure to document the reason for application submittal.
• "Change" was selected in 1A, but no indication was given
of what was changing.
• The effective date for the change, add or deletion was
missing.
• Application not signed or dated.
• IRS tax identification or documentation not received.
Slide 54 Out of 58
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Application Processing
Reminders
1. Request and obtain an National Provider Identifier (NPI) before enrolling or making a change.
Once it is determined that the application will not be returned,
it goes through different phases of verification, validation, and
then on to final processing.
If additional information is needed during these phases of
processing the application, you could receive a telephone call
or a letter requesting the information.
This phone call or letter will be directed to the person listed
on this application as the contact person in Section 13 of the
CMS-855B form.
Slide 55 Out of 58
2. The CMS-855B application is not complete.
A CMS-855B application must be completed by all organizations that will be billing Medicare carriers for medical services
furnished to Medicare beneficiaries. This form must also be completed if a tax ID number has changed for an established
organization.
3. CP575 not submitted.
A CP575 must be submitted with the CMS-855I and the CMS-855B application anytime a tax ID number is used. The CP575
is the official letter from the IRS confirming the tax identification number with the legal business name. If the CP575 is not
available, we will also accept a copy of the quarterly tax payment coupon or any official letter from the IRS that lists the legal
business name and tax ID number.
4 Include all necessary supporting documentation.
4.
documentation
This supporting documentation includes professional licenses, business licenses, certifications, IRS form (CP575), the
National Provider Identifier (NPI) notification and the 588 authorization form for Electronic Funds Transfer (EFT).
Congratulations, you have completed the CMS-855B
enrollment form CBT.
Prior to mailing the form, review the application to ensure all
Items are completed, if appropriate, and copies of all
Attachments are included.
If you have any questions, contact Provider Enrollment for
your area:
5. Complete the application in its entirety.
Each section of the application should be completed. If a section does not apply, check the “not applicable” statement where
appropriate and skip to the next section.
• Texas and Indian Health facilities:
(866) 528-1602.
6. Identify a contact person.
Once your application has passed CMS prescreening guidelines, a provider enrollment analyst will conduct research and
validation of the enrollment application. By identifying a contact person who is familiar with the application and who has access
to the physician, practitioner or administrator, you can help our analyst obtain the necessary information and/or documentation
in a timely manner.
• Virginia:
(866) 697-9670.
7. Sign and date the application.
In accordance with CMS regulations, any unsigned CMS-855 applications will be returned to the applicant and any changes
requested must include the effective date of the change.
• DC/Delaware/Maryland:
(866) 828-6254.
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3/13/2008
Thank you for participating in this
Computer--Based Training
Computer
Provider Enrollment
and
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