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SS MHC Request for Access to/Authorization for Use and Disclosure of Protected Health Information Name of SS MHC Entity maintaining the information that is subject to this Authorization: PATIENT NAME:
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What is name of ssmhc entity?
The name of ssmhc entity is the official name of the Shared Savings Program Accountable Care Organization (ACO) entity.
Who is required to file name of ssmhc entity?
The Authorized Representative of the ACO entity is required to file the name of ssmhc entity.
How to fill out name of ssmhc entity?
The name of ssmhc entity can be filled out on the appropriate form provided by the Centers for Medicare & Medicaid Services (CMS) or through the ACO Management System (ACO-MS).
What is the purpose of name of ssmhc entity?
The purpose of the name of ssmhc entity is to identify the ACO entity and ensure accurate reporting and communication.
What information must be reported on name of ssmhc entity?
The name of ssmhc entity must include the legal name of the ACO entity as registered with CMS.
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