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New Facility Information

Hispanic Senior Couple Patient with Doctor

FIRST STEP: Notify your Network of your intention to open a new unit

  • Fill out and print the New Facility Information Form (pdf) then Fax to your Network:
    • Netowrk 7 at 813.354.1514
    • Network 13 at 405.942.6884
    • Network 15 at 303.860.8392
    • Network 17 at 415.897.2422
  • Begin registering users in QIMS (Quality Identity Management System) so that your staff will have access to CROWNWeb. For more information about registering users go to our CROWNWeb page.

SECOND STEP: Peruse our website to learn more about your Network 

  • Visit the resources below which covers topics such as:
    • Conditions for Coverage
    • Quality Incentive Program
    • NHSN
    • CROWNWeb
    • Patient and Family Engagement

THIRD STEP: Submit the following as soon as you start seeing patients (prior to receiving Medicare license):

  • Memo of Understanding
  • Patient data in CROWNWeb as needed. To include: admits and discharges, the CMS-2728, CMS-2746, and clinical data. For more info see our CROWNWeb page.

FOURTH STEP: Receive your CMS letter approving your participation in ESRD program

  • Immediately notify Network 15, and FAX a copy of your approval letter to us at 303.860.8392.
  • Feel free to contact us with any other questions you have at: 303.831.8818.

We welcome you, and look forward to working with you!

New Facility Information Form - Network 7

Information form for new dialysis facilities.

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New Facility Information Form - Network 15

Information form for new dialysis facilities.

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CROWNWeb is a web-based data-collection system that allows Medicare-licensed facilities to transmit ESRD-patient data electronically to Medicare (CMS).

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National Healthcare Safety Network (NHSN)

CDC’s National Healthcare Safety Network is the nation’s most widely used healthcare-associated infection tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.

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Conditions for Coverage

CMS ESRD Conditions for Coverage (CfCs). CMS develops CfCs that healthcare organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These minimum health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries.

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