To request a new site implementation or to renew a group reporting order for an existing site, fill out the enrollment form. If your site is reporting as individual providers AND you reported with Clinigence in previous years, use the Self-Service MIPS Reorder form. See The MIPS Self-Service Renewal Process for additional information.
Link to the New Practice/Group Reporting form: ttps://goo.gl/FWoUKR
Page 1 - Basic Information
All fields with an * are required.
Page 2 - Measure Selection
Page 3 - Improvement Activities
Submitting the Form
When all the required information is entered and you have selected the measures and (optionally) the improvement activities you can submit the order. A copy of the order will be sent to the email address of the practice contact you entered on page 1 of the form.
After you have successfully submitted the form, be sure to complete the appropriate consent form and email it to email@example.com
If the practice is participating in MIPS as individual providers each provider will need to complete and sign this consent form.
If the practice is participating in MIPS as a group the group's security officer should complete and sign one consent form.