If you would like the PPRNet Qualified Clinical Data Registry (QCDR) to submit data on your behalf to CMS, please fill out a separate registration form for each provider in your practice. Please be sure to provide the correct TIN and NPI for each individual provider.

NOTE: EPs (Eligible Providers) already registered via another mechanism for data submssions to CMS are not eligible to participate with PPRNet-QCDR for 2017 data submissions; this includes practices registered with advanced APMs.

To complete your registration, please scan the following and email to pprnet@musc.edu. Alternatively you can fax to 843-876-1211.

1. An updated BAA (Business Associate's Agreement). If you have NOT updated your BAA within the last year, please submit the one available here.

2. Written permission from each provider authorizing PPRNet-QCDR to submit data to CMS on their behalf. Please complete this form.

3. Tax documentation to verify the practice's tax identification number (TIN)

4. A copy of an actual Medicare claim form (typically, form 1500) for each provider to verify NPI. You may redact patient identifier data on the form.


Other Participation Requirements:

Extract and send your data to PPRNet at least 4 times in 2017. Review your performance reports and make data collection changes as needed to insure accurate data.

Beginning in January 2018, your practice will participate in an audit to verify the accuracy of the data we will submit. Please plan accordingly.

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