Required Documentation
Eligible Professionals: Required Documentation
The following documents must be uploaded with your application:
- Copy of the Practice Management Report supporting your volume.
- Copy of the encounter report supporting the denominator (total encounters) for General Requirement 1 (50% of all encounters during the EHR reporting period were at locations with CEHRT).
- Documentation from your EHR vendor stating the date you installed the 2014 or 2015 edition CEHRT.
- MU Measure Report for the EHR reporting period including all measures and Clinical Quality Measure (CQM) information.
- Documentation from Florida SHOTS, if not excluding because you provided no immunizations.
- If attesting to active engagement for public health or clinical data registry, documentation of active engagement or a letter signed by the provider supporting that they meet exclusion criteria.
- If excluding from a Specialized Registry, a signed letter from the provider supporting that they meet the exclusion criteria.
- Copy of completed Security Risk Assessment (SRA) or review.
AS APPLICABLE
- Additional Documentation Form if practicing at multiple locations.
- Physician Assistant (PA) Led Attestation Form.
- Advanced Registered Nurse Practitioners (ARNPs) or PAs billing under a supervising physician must include a copy of a medical record supporting your provision of a Medicaid service
