Cms-10267

PRA Package CMS-10267

QualityNet Identity Management System (QIMS) Account Form

The current QualityNet Identity Management System (QIMS) Account Form that received PRA approval in March 2011 has changed. Documented below are the non-material changes for the new version of the QIMS form.

1. Page 1 – Part A

   1. Under ACCOUNT INFORMATION header, instructions were added for clarification – “Specify the types(s) of account that is being requested. If requesting a Security Official Account for an organization without one in place this form must be signed by a Notary of the Public who satisfactorily proofed the identity of the individual.”

   2. 2 additional check boxes were added to TYPE OF REQUEST – Create End User Manager Account and Disable Account.

   3. Removed 4 check boxes from ORGANIZATION LEVEL.

   4. Under BUSINESS INFORMATION header, instructions were added for clarification – “This information is provided to verify affiliation with a qualified healthcare organization.”

2. Page 2 – Part A

   1. Under SIGNATURE OF MANAGER, added “ End User Manager)” to provide clarification on which manager must give authorization.

   2. Changed the check box selections in APPLICATIONS TO BE ACCESSED. (Removed MIS, QIES, QMIS and PQRI. Added QIO DDST, QIO Mart and Hospital Reporting.)

   3. Removed “2^nd factor Credential Required Query” from the form.

   4. Removed “Preferred 2^nd Factor Point of Contact” from the form.

3. Page 3 – Part B

   1. Under FACILITY SCOPE HEADER, instructions were added for clarification – “If the Applicant requires and is approved for Scope over more than ONE dialysis facility, the following section is required and must follow the SPECIAL ROUTING INSTRUCTIONS FOR ADDITIONAL FACILITY SCOPE on Page 4 of this form”

   2. Added 4 additional rows under facility scope (to specify multiple Facility Name, Name of Facility Contact, Contact Phone and Contact E-mail) as requested by the user community because numerous individuals work for more than one facility. This expansion capability eliminates the need for those individuals to submit multiple forms.

4. Page 4 – Instructions

   1. Third bullet – modified instructions due to change in Help Desk contract to reflect new procedures and the new contact and address information. Changes included:

      1. All forms are not required to be notarized any longer, only Security Official’s need to have notarized forms.

      2. There is no longer a waiting period for the help desk to activate the QIMS account.

      3. Mailing options were expanded. Originally all forms had to be mailed USPS Certified, now any trackable mail with receipt by commercial carrier can be used.