|
Please submit this form to let us know of your interest. We'll provide you with more information within 48 hours letting you know who to contact for questions and assistance.
|
| Organization Name*: |
|
| Organization Address*: |
|
| Organization Contact*: |
|
| Phone*: |
|
| Email*: |
|
|
The following will help us match you to a performance assessment organization. Please be as specific as possible:
|
| What products/services does your organization offer? |
|
| What is your product/service's geographic footprint and respective volume of participating physicians? |
|
| Is your product CCHIT or Meaningful Use certified? |
Yes: No: |
| Has your product been approved for PQRI submission to CMS? |
Yes: No: |
|
Do you currently capture data for all the clinical measures assessed in the BTE Care Programs you wish to implement? If not, which ones are missing?
|
|
|
Is medical record data captured and stored centrally or is it housed on site at each physician practice?
|
|
|
Do you have xml capabilities?
|
Yes: No: |
| What is your estimated timeline for submitting your first test file? |
|
| |
|