The Bureau of Provider Enrollment is interested in hearing what you think about the New Provider, Revalidation, and Enrollment Maintenance Processes. Please answer the questions below. 

Describe a common rejection you have received when attempting to enroll or update your provider file. What was the form? What part of the instructions were difficult to follow? What would you change?

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* 1. Describe a common rejection you have received when attempting to enroll or update your provider file. What was the form? What part of the instructions were difficult to follow? What would you change?

What is the most difficult part of the revalidating process?

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* 2. What is the most difficult part of the revalidating process?

Describe your experience using emedny.org to find enrollment and maintenance forms.

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* 3. Describe your experience using emedny.org to find enrollment and maintenance forms.

Would you be interested in taking a course on how to complete enrollment maintenance forms?

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* 4. Would you be interested in taking a course on how to complete enrollment maintenance forms?

Please enter any other comments that the Department may find useful here.

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* 5. Please enter any other comments that the Department may find useful here.

Rate the following forms according to one of the categories below.

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* 6. Rate the following forms according to one of the categories below.

  The form is easy to complete. I do not get rejections for this form. I occasionally get rejections on this form and I understand why. Requires multiple readings of instructions to complete; I regularly get rejections for this form. My provider type does not use this form.
Disclosure of Ownership and Control Section of Provider Enrollment Form
Electronic or PDF Remittance Request
Electronic/Paper Transmitter Identification Number (ETIN) Application
Group Member Affiliation/Disaffiliation
Notification of Status as Group-only Practitioner
Electronic/Paper Transmitter Identification Number (ETIN) Application

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