Pre-Application Accreditation Form

Pre-Application Accreditation Form

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Becoming a candidate for EHNAC accreditation is an easy, two-step process.

Answer the few short questions listed in the pre-application form below.
Submit the Applicant Agreement and Sentinel Events documents. These documents must be signed by a representative authorized to bind the applicant to those terms and conditions and faxed to 860-760-6630 or uploaded through the EHNAC portal.

Upon review and qualification, EHNAC will send you the electronic address to complete the accreditation application(s) for EHNAC candidate status.

Please Note: For each candidate, EHNAC accreditation requires that a Self-Assessment be completed and that site visits be conducted at each site in which Essential Functions ensure the appropriate administrative, physical, and technical safeguards are in place and enforced for the protection of PHI.

Program fees
The cost for EHNAC Accreditation is dependent upon both the size of your organization and the number of programs selected. Please refer to EHNAC’s Cost Calculation document for more details.

Program Selection
To learn which EHNAC Program(s) is right for your organization, visit our Program Page or Program Selection Guide.

EHNAC Accreditation Program(s) Desired:(Check all that apply)

ePAP
FSAP-EHN
HIEAP

HNAP-EHN
HNAP-Medical Biller
HNAP-Payer
HNAP-TPA
HNAP-70

MSOAP

OSAP Data Host
OSAP Administrator
OSAP Customer Service
OSAP Product Development
OSAP Disaster Recovery
OSAP Backup Storage
OSAP Printing
OSAP Scanning
OSAP HIE

Personal and Organization Information:
Contact Name:
Title:
Name of Organization:
Contact Email
Organization Website:
Telephone:
Organization Address:
How did you hear about EHNAC?
Other (please explain)
Is your organization the corporate entity or a subsidiary of a larger organization?*
Name of Parent Organization (if applicable):
Is your organization CAQH CORE certified?
Program Specific Revenue

INSTRUCTIONS
EHNAC site reviews are particularly focused on the security of all protected health information (PHI). Therefore, all sites in which PHI is accessed must be physically reviewed. I f any services are outsourced, the vendor sites must also be physically reviewed. Please identify each of your organization’s sites as well as the sites of any outsourced service providers. Also specify an EHNAC program associated with each site.

Comments (Add any information that may be pertinent to your organization)

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EHNAC Mission Statement

To promote standards-based accreditation within the healthcare data exchange industry

EHNAC Mission Statement

Process