As an EHR Data Submissions Vendor (DSV) and as a Qualified Registry, Clinigence is approved to submit data on behalf of a provider or group but only if the provider has completed and signed a form giving consent for Clinigence to provide this service.  Instructions to the provider and group are included in the forms.  

Clinigence Partners

Clinigence partners may choose to brand these forms by modifying the appropriate form individual provider or group form labeled "Brandable Consent Form".  You will need a PDF editor application to add your own branding.  

Group Practices

A group of providers participating in PQRS as a part of the Group Practice Reporting Option (GPRO)

  1. Must all file their Medicare Part B, Secondary, and Railroad claims under the same TIN.
  2. Only needs to complete one form for the group.
  3. Must register in the GPRO program before September 2014.
  4. Must have the form filled out and signed by their GPRO security officer.

Individual Providers

For every provider not participating as a part of a group it is also important to know that

  1. No one else can sign for the provider and
  2. If multiple providers in a practice are participating in PQRS each of them must fill out and sign their own form.