CHAP Application

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.