EVV Registration

This form is for the purpose of Electronic Visit Verification (EVV) registration as mandated by the 21st Century Cures Act and the CO Department of Health Care Policy and Financing. Please complete the entire form and review for accuracy before submitting. Palco will use this information to register you for EVV. You will receive an email with more information on using EVV in the coming weeks. Please fill out the form multiple times if you are an employer with multiple employees. Deadline to register is 03/12/2021.
 
Note: All live-in exemption information was transferred from Acumen. If you had an exemption with them, you do not need to complete this form. If you would like to apply for a new live-in exemption, please click here for the form.
 
PALCO ID NUMBERS WILL BE PROVIDED VIA EMAIL THE WEEK OF 2/22/21.


The EVV Application Palco uses is called AuthentiCare. This is a different app than Acumen. Please ensure your review the EVV materials located on the Palco website and plan to attend training for more inforamtion https://palcofirst.com/colorado/ 

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* 1. PARTICIPANT Full Name (First, Middle, Last)

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* 2. PARTICIPANT Palco ID

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* 3. PARTICIPANT Email Address

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* 4. EMPLOYER Full Name (First, MI, Last)

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* 5. EMPLOYER Palco ID

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* 6. EMPLOYER Email Address

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* 7. Your Attendants Full Name (First, Middle, Last)

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* 8. Your Attendant Palco ID

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* 9. Your Attendants Email Address

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* 10. Choose your method of EVV:

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* 11. If you chose "Telephony/IVR" option for Question 10, Enter the Participants Landline Phone Number:

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* 12. If you chose "Mobile Application" option for Question 10, Enter your Mobile Device ID.

For information on how to find your Authenticare Mobile Device ID, Click Here.

Your Device ID is NOT your phone number or serial number!!! It must come from the AuthentiCare application. Please use the instructions. Failure to provide a valid device ID will result in your inability to log in on 3/16. 

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