CHAP ONLINE ENROLLMENT INSTRUCTIONS
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
“CLICK HERE”
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.
CHAP Application for CHAP Accreditation.