Instructions For
CHAP On-Line Enrollment Application
| NOTE: Before starting the application have available your Agency address, phone number and fax and your EIN and NPI numbers | |
| Go to www.chapinc.org Click on Accreditation Process Click on Application for Accreditation In Second Paragraph Click on “CLICK HERE” |
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| Page
1 Enter EIN Number Enter name and email address Create password Click on Create Account Page 2 Enter Agency name CEO (you) name and title CHOOSE Single location Branches -0 Sub-Units – 0 CHOOSE - Independent Free Standing CHOOSE – Proprietary For Profit Is Parent Applying – Answer YES Enter Street Address, Name of Contact (You), phone and fax Page 3 Enter Agency name and address CHOOSE - Main Office Enter NPI number Leave Medicare BLANK Leave Medicaid BLANK Leave License BLANK Enter Date that is ten days prior to the date of the Application MILES TO PARENT -- ENTER 0 Page 4 CHOOSE CORE CHOOSE HOME HEALTH Page 5 CENSUS –0 Accreditation with – No Medicare accreditation Total Admissions –O Page 6 Review Information and Submit Within a couple of hours you will receive an EMAIL acknowledgment. Save a copy and forward it to your contact at 21st Century. Print it out and mail it to the address given in the acknowledgment with a check for $500.00 |
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