Recognition Program Multi-Site Online Application & Payment Submission Process Guide · 2016-05-31 · 3 Multi-Site Online Application & Payment Submission Process Guide May 2016

Recognition Program

Multi-Site Online Application &

Payment Submission

Process Guide

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the written permission of NCQA.

© 2015 by the National Committee for Quality Assurance 1100 13th Street, NW, Suite 1000 Washington, DC 20005 www.ncqa.org

All rights reserved. Printed in the U.S.A.

NCQA Customer Support: 888-275-7585

http://www.ncqa.org/

Multi-Site Online Application & Payment Submission Process Guide May 2016

Introduction

Thank you for your interest in NCQA’s Patient Centered Medical Home (PCMH) or Patient-Centered Specialty Practice

(PCSP) Recognition Programs. This document provides instructions for submitting your Application to NCQA prior to

completing either your PCMH 2014 or PCSP 2013 Survey.

The patient‐centered medical home (PCMH) is a model for care provided by medical practices that seeks to strengthen

the clinician‐patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated

care and a long‐term healing relationship. The American College of Physicians, the American Academy of Family

Physicians, the American Academy of Pediatrics and the American Osteopathic Association have jointly defined the

medical home as a model of care where each patient has an ongoing relationship with a personal physician who leads a

team that takes collective responsibility for patient care. The physician‐led care team is responsible for providing all the

patient’s health care needs and, when needed, arranges for appropriate care with other qualified clinicians.

A medical home also emphasizes enhanced care through open scheduling, expanded hours and communication between

patients, clinicians and staff.

The PCMH & PCSP Recognition Programs are health care settings that facilitate partnerships between individual

patients, and their personal Clinicians, and when appropriate, the patient’s family. Care is facilitated by registries,

information technology, health information exchange and other means to assure that patients get the indicated care when

and where they need and want it in a culturally and linguistically appropriate manner.

The online electronic application process is intended to make PCMH & PCSP Recognition Programs application submission more efficient. The resources provided within the application module contain information about how to contact NCQA, take advantage of NCQA’s free informational programs, get your questions answered, and resolve any difficulties you may have with the program materials. NCQA looks forward to working with you to create a productive and successful experience.

Table of Contents


Table of Contents

About the Instructions ....................................................................................................................... 1

Accessing the NCQA Store ............................................................................................................... 2

Purchase the Online Application ....................................................................................................... 4

Getting Started ............................................................................................................................... 10

Log In ........................................................................................................................................ 10

License Agreement ................................................................................................................... 11

My Accounts ............................................................................................................................. 12

Home Page ............................................................................................................................... 13

Resources ................................................................................................................................. 14

Account Manager and User Information ......................................................................................... 15

Edit Account Information .......................................................................................................... 15

Add/Edit/Delete Users & Administrator ..................................................................................... 16

Legal Documents with NCQA .................................................................................................... 18

Administrative Steps and Document Submission ........................................................................... 19

Information Entry Sessions ...................................................................................................... 19

Completing Practice Site Information ............................................................................................. 20

Edit a Practice Site ................................................................................................................... 24

Multi-sites ................................................................................................................................. 25

Order Survey Tools for Multi-Site Surveys ............................................................................... 30

Completing the Legal Agreements, Adding Applications, and Entering Clinician Information .......... 33

Completing the Legal Agreements ........................................................................................... 33

Adding Applications to Practice Sites ....................................................................................... 36

Adding Clinicians to Practice Sites ........................................................................................... 40

Adding Clinicians to an Application .......................................................................................... 42

Submitting/Payment Process ......................................................................................................... 44

Feedback ........................................................................................................................................ 49

1


About the Instructions

The Online Application is a Web-based module that PCMH, PCSP & PCCC applicants use to submit orders for survey tools and to submit applications necessary to seek NCQA Recognition and to set up multi-site submissions. The Recognition Program Online Application Instructions guides applicants through the process of entering the following information directly into the Online Application.

Account/User information—enter once per account—there may be multiple users per account.

Practice site information—enter once per practice site—there may be multiple practice sites per account.

Clinician information—enter once per Clinician—there may be multiple clinicians per practice site.

Application information—enter once per Application—there may be multiple applications per practice site.

NCQA only accepts submissions that have been entered into the Online Application.

Online Application

The Online Application collects information in tables, or subsections. For each table, the introductory section focuses on how to navigate the Online Application.

Instruction Conventions

NCQA uses the following conventions in these instructions.

References to documents (e.g., PCMH Requirements) are in italics

References to tabs or items on the Main Menu of the Web-based Application (e.g., Practice Sites ) are in bold italics

References to links (e.g., Add Practice Site) are in bold underline

References to drop-down menu choices (e.g., “Yes” and “No”) are in “quotations”

Important notes are in bold and are in shaded boxes

2


Setup/Access NCQA Store Account

Access the NCQA Store to purchase an Online Application by following these steps:

A. Enter store.ncqa.org into the address window of your internet browser or search engine.

B. Select Log In beside the Search engine at the top of the page.

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C. NOTE: If you have an my.NCQA,org account, you may use the same log-in information to log into the NCQA Store.

D. Log-in to the NCQA Store account under Registered Customers with your e-mail address and password.

E. Select Create an Account and complete the form, if you do not have an account.

https://my.ncqa.org/

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F. After completing the registration form, select My Account to confirm your NCQA Store account information in correct.

NOTE: The NCQA Store account name will be added as the Online Application account name; however, you may change the name if it is not correct under the Account Manager tab in the tool.

Purchase Online Application from NCQA Store

A. Under the Recognition tab, select the applicable program, e.g., Patient-Centered Medical Home (PCMH), from the dropdown menu.

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B. Use the Search engine to locate the appropriate product, e.g., 2014 PCMH Online Application, then click Add to Cart.

C. Once item moved to the Shopping Cart: a. Confirm the correct product has been selected. b. Confirm the quantity under the Qty column. c. Enter any applicable Discount Codes, then click Apply Voucher. d. Get Shipping & Tax estimate quote, by selecting Get a Quote. e. Click Proceed to Checkout.

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D. Please verify Shipping Information, Shipping Method, Payment Information and Order Review before checking out.

E. Agree to all terms and condition, then select Place Order to proceed.

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F. The confirmation of the order will appear including the order number.

G. The order, payment and system access e-mail confirmations will be received. See examples below.

Email 1: Confirmation of Application and Survey Tool Purchase

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Email 2: Payment Confirmation

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Email 3: Username and Password to access Online Application Tool Email 3: Username and Password to access Online Application Tool (Continued)

Eyram Bruce

NCQA

11100 13th street NW

Washington, DC 20005

Phone:

E-mail:[email protected]

RE: Order Number: 100016979

***IMPORTANT - KEEP THIS EMAIL FOR YOUR RECORDS ***

Thank you for your order. You have purchased the following product(s) from NCQA:

2014 PCMH and CAHPS-PCMH Online Application

Your user name follows and allows you to access your product(s).

User Name: [email protected]

Password: *************

Link: http://stagend01.ncqa.org/Development/Ncqa.Rp/Ncqa.Rp.OnlineApp.Web/Login.aspx

ACCESS PRODUCT

To access the product, enter your User Name and password at the link above. For your convenience, we suggest

that you bookmark this Web page or add it to your Favorites list.

Please contact NCQA Customer Support at 888/275-7585 with any questions. Thank you.

http://stagend01.ncqa.org/Development/Ncqa.Rp/Ncqa.Rp.OnlineApp.Web/Login.aspx

10


Getting Started

Log In

Follow these steps after you have received an e-mail from NCQA with your User ID and Password.

Step 1 Navigate your Web browser to https://recognitionportal.ncqa.org/rponlineapp/Login.aspx.

Step 2 Enter your Username and Password from the e-mail you should have received from [email protected] when you ordered the PCMH or PCSP Online Application.

Step 3 Click Login.

This section provides instructions that pertain only to the

Online Application.

https://recognitionportal.ncqa.org/rponlineapp/Login.aspx

mailto:[email protected]

11


License Agreement

The Software License Agreement is a legal agreement between your organization and NCQA. It permits you to access and use the Online Application.

You will be required to accept the License Agreement each time you log in to the Application.

Step 1 Use the scroll bar to read the entire license agreement.

Step 2 Click I Agree to confirm acceptance of this agreement.

Note: If you click I Disagree, you will not have access to the Application.

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My Accounts

Step 3

You will be directed to the My Accounts page. Select the account you would like to work with. Only one or multiple accounts may appear.

Step 4 Verify your account information when first logging into each account. The information that is displayed is what we currently have regarding your account created by your order. Review and change any information so that we can update our records.

Step 5 Click Save/Verified to save and continue.

13


Home Page

The Home Page of the Online Application outlines the areas of the Application you must complete in order to submit. The page also includes links to NCQA’s other Recognition Programs and links to resources and documents that will help you complete the Application. You will be brought to the Home Page after logging in and selecting your account.

Step 6 Use the tabs in the tool bar to navigate through the pages of the Online Application you must complete.

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Resources

Step 7 Refer to the Resources tab with any questions. We have provided some helpful documents on the Resources page to help you get started and to answer some questions you might have. **If you have purchased PCMH 2014 and/or PCSP 2013 you will need to select the appropriate button to view PCMH 2014 or PCSP 2013 Resources.

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Account Manager and User Information

Edit Account Information

Step 1 Click Account Manager on tool bar.

Step 2 Click Edit in Account Information box.

Step 3 Enter information into the fields following the format and instructions below.

Field Name Information Format Instructions

Account Name Text Field Enter name associated with account.

Address 1, 2, 3 Text Field Enter the number and street mailing address of the practice.

City Text Field Enter the city name.

State Drop-Down Select the state from the list in the drop-down menu.

Zip Number Enter the zip code.

Tax ID Text Field Enter the Practice’s Tax Identification number.

Account Telephone Number Number (XXX) XXX-XXXX

Enter the telephone number of the primary person tied to the account.

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FAX Number (XXX) XXX-XXXX

Enter the fax number of the account.

Contact Information

A Contact Person Text Field (First, Last) Enter first and last name for the person whom NCQA can contact regarding the Application.

E-mail Text Field; must include @ Enter the e-mail of the contact person.

Contact Title Text Field Enter the title of the contact person.

Contact Phone Number Number (XXX) XXX-XXXX

Enter the telephone number of the contact person.

Step 4

Click Save/Update to save account information.

Add/Edit/Delete Users & Administrator

Multiple users are able enter information into the Online Application. You are able to set-up multiple users with their own unique username and password to access the account.

Step 1 On the Account Manager page, Click Add Users


Username Text Field Enter e-mail address of user.

Password Text Field Enter a password that meets the following requirements:

8-20 characters in length

Contain at least one digit, at least one upper-case letter, at least one lower-case letter, and at least one symbol such as $

Password (confirm) Text Field Re-enter password.

E-mail Text Field; must include @ Enter e-mail address of user.

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Step 2 Click Save/Update.

Step 3

Check proper roles are assigned to user: sysuser - a user able to view/edit the Online Application sysdmin - administrator of account If you need to change the role of user select the role and Click >,< buttons to change the role status.

Step 4

To save and close a user Click the X button at the top right hand of box.

Step 5

To edit a user Click Edit User on the username line under Modify on the Account Manager page.

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Legal Documents with NCQA

Before you can submit a PCMH 2014 or PCSP 2013 Application to NCQA, you must sign the Business Associate Agreement (BAA), and the PCMH 2014 or the PCSP 2013 Agreement electronically or manually based on which application you are submitting. If you are just submitting for PCMH 2014 you just need to sign the PCMH 2014 Agreement. If you are only submitting for PCSP 2013 you need to sign the PCSP 2013 Agreement. For either application the BAA must be signed.

See page # 33 for instructions.

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Administrative Steps and Document Submission

Information Entry Sessions

Separate information entry sessions: You may work on the Online Application in as many time periods as you like; the module saves your information from one work session to the next.

Multiple users for information entry: You may set up multiple users to access and to enter information into the Online Application.

Logout: When you are finished with a session, click Logout to close the Online Application.

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Completing Practice Site Information

You must complete the Practice Site Information first for each Online Application. You only need to enter information for each practice site once.

Step 1 From the Home Page, Click on Practice Sites page on the tool bar.

Step 2 You will be sent to the Practice Sites page.

Step 3 Answer the question “Do you have more than one site?” (If YES continue to the next step. If you answer NO, look for further instructions in the Recognition Program Single Site Online Application & Payment Submission Process Guide)

Step 4 Click Add Practice Site

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Step 5 Enter information into the fields following the format and instructions below. (Required fields are

denoted by *.)


Your Practice Site Name * Text Field Enter the legal name of the practice. If the applicant is a solo practice or an individual Clinician applicant, enter the Clinician’s name.

Sponsor Name Text Field Enter the legal name of the sponsor, if you are a participant in a sponsored PCMH or PPC project.

Practice NPI Text Field Enter the Practice NPI for the practice.

Certificate Name Text Field Enter the name of the practice as it will appear on the certificate.

Address 1, 2, 3 * Text Field Enter the number and street mailing address of the practice.

City * Text Field Enter the city name.

State * Drop-Down Select the state from the list in the drop-down menu.

Zip * Number Enter the zip code. You may enter the zip code + 4 here. **If you are in NY State you need to enter your zip code + 4 in order to participate in the NYS Medicaid Medical Home reimbursement program for PCMH.

Practice Telephone Number Number (XXX) XXX-XXXX

Enter the telephone number of the practice.

FAX Number (XXX) XXX-XXXX

Enter the fax number of the practice.

Mailing Address Check Box Select box if the mailing address is the same as the practice site address.

Address 1, 2, 3 Text Field Enter the number and street mailing address of the practice.

City Text Field Enter the city name.

State Drop-Down Select the state from the list in the drop-down menu.

Zip Number Enter the zip code.

Primary Contact Information

Contact Person * Text Field (First, Last) Enter first and last name for the person whom NCQA can contact regarding the Application.

E-mail * Text Field; must include @ Enter the e-mail of the contact person.

Title Text Field Enter the title of the contact person.

Phone Number * Number (XXX) XXX-XXXX

Enter the telephone number of the contact person.

**NOTE: If you are in NY State you need to enter your zip code + 4 in order to participate in the NYS Medicaid Medical Home reimbursement program for PCMH.

Step 6 Click Save/Update to save information.

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Step 7 Enter more practice sites if needed by clicking on Add Practice Site. Follow the naming convention when entering your practice sites:

**For the practice site names, please use the naming convention:

ABC Medical Group – Reston Internal Medicine

ABC Medical Group – Annapolis Pediatrics

ABC Medical Group – Alexandria Health, Inc.

ABC Medical Group – Elliott City Family Medicine

**NOTE: The Multi-Site Corporate Site will be automatically added. You may change the name under the Account Manager tab if it is incorrect. The Corporate Site and EHR name will be automatically added to the practice site after the application is submitted.

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Adding Practice Site in Multi-Site application:

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Edit a Practice Site

Step 1 Click on the [Site Name] under the Name column on Practice Sites page.

Step 2 Click Edit in Practice Site Information box.

Step 3 Edit information.


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Multi-Sites

Step 1 If you answer YES to “Do you have more than one site?” follow these steps.

Step 2 Select Add Multi-Site Request to see if you are eligible for a multi-site submission.

Step 3 You will be directed to the Multi-Site Request form page.

Step 4 Read through the instructions and answer the eligibility questions. **If you answer no to any of the questions you are not eligible to apply for a multi-site application. You will need to return to the Practice Sites page and enter you practice site(s) as single site(s).

http://stagend01.ncqa.org/Development/Ncqa.OnlineApp.Rp/Ncqa.OnlineApp.Rp.Web/MultiSiteEligibility.aspx

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Step 5 If you are eligible for a multi-site application, you will see the Status on the Multi-Site Manager page change from Submitted to Approved.

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Step 6

After approval of the Multi-Site, the Multi-site group will be created. You will receive a NCQA Auto email as well about the application. Please do not purchase any survey tools until NCQA’s approval.

Step 7 After approval, open the Multi-site Group window, click on the EHR product name (default).

Step 8

Click in the Group Name field and replace the EHR product name with the correct [Multi-Site

Corporate] Name.

Step 9 Reenter the Multi-Site Group window and check the boxes of the practice sites that are a part of

the Multi-Site survey.

**NOTE: If more practice sites need to be added to the multi-site, return to the Practice Site

tab and enter the additional sites.

Make sure to only add sites that correspond to practices that have identical EHR systems.

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Step 9 Under Multi-Site Groups, the [Multi-Site Corporate] Name will be updated as well as the number

of Site(s) to coincide with the practice sites selected in the Multi-Site Group window.

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Order Survey Tools for Multi-Site Surveys

Step 1 Click the Multi-Site Manager tab on the top menu bar.

Step 2 Click the name of the Multi-site Group.

Step 3 In the Multi-Site Group window check the boxes for all the appropriate practices.

3

2

1

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Step 4 Under Multi-Site Actions, click Order Survey Tools link.

Step 5 Complete the Practice Site list form:

a. Check the boxes of the sites requiring an ISS Survey Tool and enter payment information.

b. Print and Fax, 202-955-3599 (ATTN: Customer Support), OR Scan and E-mail,

[email protected].

**NOTE: If you purchase an additional product, e.g., PCSP 2013, and have 3 or more practices with a different Electronic Health Record (EHR), those practices will be listed with the other practice sites list in the Multi-Site Group window. Unselect the previously checked boxes and select only those pertaining to the new product or EHR system.

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Step 6 To calculate the cost of your Multi-Site survey, click Fee Calculator under Multi-Site Forms.

Step 7 Follow the instructions in the fee calculator.

Example of a completed Multi-Site Fee Calculator.

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Completing the Legal Agreements, Adding Applications, and

Adding Clinician Information

Completing the Legal Agreements

If you have not completed the Business Associate Agreement (BAA), PCMH 2014, or PCSP 2013 Agreement

for your organization you will need to do so before submitting your Application. You may access all of the

legal agreements for electronic or manual signature from the Account Manager screen.

If you choose not to sign one or all of the legal documents electronically, you will need to download the

appropriate document(s) and send in a signed hard copy of the document(s) to NCQA. To obtain a hard

copy of the document(s) click on the document name. Then select the Click Here link on the document(s)

starting page. Print out the document(s). If you have any changes you must red line them and the

changes must be visible. Mail the signed copy(s) to NCQA at the following address. You will be notified by

e-mail when the document(s) have been accepted and uploaded to your account.

NCQA Patient Centered Medical Home Recognition Program

1100 13th Street NW, Suite 1000 Washington, DC 20005

Follow these steps to complete your legal document(s) electronically. Below are the screen shots and steps

for the BAA. The screens and steps are similar for the other legal document(s).

** If you are just submitting for PCMH 2014 you just need to sign the PCMH 2014 Agreement. If you are just

submitting for PCSP 2013 you need to sign the PCSP 2013 Agreement. For either application the BAA must

be signed.

Step 1 Click BAA in the Legal Document box on the Account Manager page.

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Step 2 Read through Business Associate Agreement starting screen.

Step 3 Click Begin Electronic BAA.

Step 4 Enter information into the fields following the format and instructions below. (Required fields are denoted by *.)


Authorized Representative Name *

Text Field Enter the representative’s first and last names in the fields.

Title of Representative * Text Field Enter the title of the representative.

Organization Covered Entity* Text Field Enter the name of the person responsible for signing the agreement.

Covered Entity Attention To * Text Field Enter the name of the signed party.

Covered Entity Street * Text Field Enter the number and street mailing address of the practice.

Covered Entity City/State/Zip * Text Field Enter the city name, state, and zip of the signing party.

Covered Entity E-mail * Text Field; must include @

Enter the e-mail of the signed party.

Step 5 Click Generate Agreement PDF.

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Step 6 Read through the BAA.

Step 7 Select Click to E-Sign the Document.

Step 8 You can Print or Save the document by selecting the print or save icons at the top of the agreement.

Step 9 You can access your BAA at anytime by clicking Account Manager on the toolbar.

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Adding Applications to Practice Sites

Step 1 Click Practices Sites on toolbar.

Step 2 To add an application to a practice site, click the [Site Name] under the Name column.

Multi-Site:

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Step 3 Click Add PCMH 2014 Application or Add PCSP 2013 Application.

**If you have only purchased the PCMH 2014 Application you will only have the option of adding a PCMH 2014 application to the practice site and vice versa for PCSP 2013. If you purchased more than one all that were purchased will appear.

Step 4 Enter the ISS License provided by NCQA after ordering your survey tool and click

Validate ISS License Number

Step 5 Enter information into the fields that are released after entering the Valid ISS License Number. Follow the format and instructions below. (Required fields are denoted by *). Use the table that is associated with the program you are submitting for PCMH 2014 or PCSP 2013.

Fields for PCMH 2014 & PCSP 2013 Application:


ISS License Number * Text Field Enter the License number received from NCQA after ordering survey tool(s).

Practice Site Specialties Drop-down Select primary care specialties represented at practice site.

Practice Site Sub-Specialties Check Box Select Sub- Specialties represented at practice site.

Practice Site Description Drop-down Select from the drop-down menu.

Certified HIT Products List Text Fields Enter the name of the HIT Products List associated with this practice site.

EHR Security Risk Analysis Radio Buttons Select Yes or No for the question.

Fields PCSP 2013 Application


ISS License Number * Text Field Enter the License number received from NCQA after ordering survey tool(s).

Practice Site Specialties Check Box or Drop-down

Select primary care specialties represented at practice site.

Practice Site Sub-Specialties Check Box Select Sub - Specialties represented at practice site.

Practice Site Description Drop-down Select from the drop-down menu.


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Entering ISS License Number for the Multi-Site Corporate Site:

There is no “Clinicians

at this practice site”

window under the

corporate application.

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Entering ISS License Number for a non-Corporate Site Multi-Site Practice:

If “Practice site’s

address does not

match” error

message received,

go to “Practice Site

Information”

window of the

practice site and

change the zip

code to match the

one shown in the

message. After

validating the ISS

License Number,

change the zip

code back to the

correct one.

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Adding Clinicians to Practice Sites

Step 7 Add the clinicians that are associated with the practice site.

Step 8 Click Clinicians at this Practice Site- Add/Edit/Remove.

Step 9 You will be directed to the Clinicians Page.

Step 10 Click Add Clinician.

Step 11 Enter information into the fields following the format and instructions below. (Required fields are denoted by *).


NPI Number * Text Field Enter the Clinician’s NPI number

Clinician Name * Text Field (First, Middle, Last)

Enter the Clinician’s first, middle and last names in the fields.

E-mail Text Field; must include @

Enter the e-mail of the Clinician.

Credentials Drop-down Select from the drop-down menu.

Tax ID # * Text Field Enter the Clinician’s Tax Identification Number

DEA # Text Field Enter the Clinician’s DEA number

Gender Drop-down Select Male or Female

DOB Date Enter the Clinician’s Date of Birth in format MM/DD/YYYY

License Number * Number Enter the Clinician’s license number for the state given in the Practice Site Info section (state of mailing address).

License State * Drop-down Select the state from the list in the drop-down menu.

Primary Board Specialty Drop-down Select the Clinician’s specialty (e.g., “internal medicine,” “orthopedic surgery,” chiropractic”).

Primary Board Number Text Field Enter the Clinician’s primary board number

Secondary Board Specialty Drop-down Select the Clinician’s specialty (e.g., “internal medicine,” “orthopedic surgery,” chiropractic”).

Secondary Board Number Text Field Enter the Clinician’s secondary board number

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Step 13 Click Edit to edit Clinician Information. Click Save/Update after changes are made.

Step 14 Click Add Clinician to enter more clinicians.

Step 15 If you would like to delete a clinician, click Delete under the [Action] column and then confirm

your choice by clicking Yes or No

Step 16 Add all clinicians to Application you are submitting for.

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Adding Clinicians to an Application

Step 17 To add clinician(s) to an Application, Click the link under [Clinicians] column. **The link will say Empty if no clinician(s) are tied to the Application or will show the number of clinician(s) that are entered for the Application (e.g. 2 Clinicians). You can add/delete clinicians to the unsubmitted Application at anytime

Step 18 Click Add Clinician to Application in the List of Clinicians for this Application pop up box.

Step 19 Select clinician’s name you want to add and Click Select Applicant.

Step 20 Continue to add all of the clinician(s) tied to the application.

Step 21 Once all clinicians have been added to List of Clinicians for this Application, Click Accept.

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Submitting/Payment Process

To submit and pay for your complete Multi-Site Online Application to NCQA, follow the instructions below. The six requirements for NCQA to review your information are:

Signed Legal Documents.

Purchased survey tools for each practice site.

Completed application information.

Completed clinician information.

Matching license numbers in ISS and on practice site application.

Fixed any error messages.

How to submit and pay your Application:

Step 1 Click Submit Application on tool bar.

Step 2 Review the instructions for submitting the Application.

Step 3 If you need to edit your Application click Edit in first column of table.

Step 4 If you need to delete your Application click Delete Application under the Action(s) column.

Step 5 Click the checkbox under the Select column of the appropriate practice site(s) when ready to make payment, then click Submit.

NOTE: You can pay for one or multiple practice sites at the same time.

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A message will appear stating that an order has been created for the submitted application.

Step 6

Step 7

Select the Pay link under the Action(s) column to continue with the process. Verify the webpage dialog to continue. Click the Yes option to proceed.

Step 8 An e-mail will be sent to view the order summary.

Step 9 Click on the order attachment to view the order.

Step 10 You can pay by clicking in the Online Payment link.

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Step 11 Read the Terms and Conditions to continue with the order.

a. Accept the terms and conditions by checking the box them type your full name.

b. Click Accept and Pay Online to continue.

Step 12 Verify billing information and add the form of payment.

a. Payment options:

i. eCheck.

ii. Credit Card.

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Step 13 A transaction complete page will appear and show the amount paid as well as the order number.

Step 14 If you do not receive a successful message from NCQA, please contact your assigned RP

Technical Analyst.

Step 15 If you need to request an Add-On click Request Add-On under the Action(s) column. You will only be able to do this if you already submitted an application and survey before.

NCQA will review your Online Application and notify you when you may upload your survey tool by e-mail within 5 days. Once an Application is acknowledged for submission, that Application is no longer available to un-submit.

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Feedback

NCQA welcomes any suggestions or comments you may have about the Online Application. To

submit comments, log into your My.NCQA account, my.ncqa.org, or Contact Us at www.NCQA.org.

https://my.ncqa.org/

http://www.ncqa.org/