Onboarding & Documentation Checklist

DMEPOS Supplier Accreditation

(Onboarding & Documentation Checklist)
Purpose:

The DME Client Intake Form is completed and submitted by the new DME client after service agreement execution and payment, to capture the essential information needed to confirm project scope and initiate onboarding.

The Sales Department reviews the submission and shares it with the Facility Licensing & Accreditation Department as the formal project handoff, enabling the client to receive the applicable detailed Client Discovery Form to collect information and documentation.

Please complete all applicable fields. Fields marked with an asterisk are required.

Section 1: Business and Tax Verification

Section 2: Ownership and Signing Authority

Main Accreditation / Project Contact

Section 3: NPI / NPPES Verification

Section 4: Holding Company Information

Section 5: Location Documentation

Section 6: Product Scope / Item List

Please fill & upload the Product Scope Worksheet on ShareFile - Onboarding folder. This worksheet includes specific information for all your current & potential supplies.

Section 7: Payer / Medicaid Enrollment Status

Section 8: Insurance and Bonding

Section 9: Existing Accreditation-Related Materials

Section 10: Initial Patient Record Status

Section 11: Vendor / Supplier Information

Please complete this section for each vendor, supplier, distributor, manufacturer, drop-ship partner, delivery contractor, billing vendor, software vendor, or other company involved in your DME business.

Please add a separate entry for each vendor.

Section 12: EHR System / Record Storage

Please complete this section so we can understand how patient/client records, business records, accreditation documents, and compliance documentation are stored and maintained.

Privacy, Security & Technology Requirements

Please review the following requirements carefully before submitting this DMEPOS Supplier Accreditation onboarding form.

Privacy, Confidentiality, and Security of Credentialing Documents

To maintain compliance with HIPAA and to safeguard Client privacy, confidentiality, and data security, TriumpHealth strictly prohibits the transmission of credentialing, accreditation, payer, patient, financial, or other sensitive documents through unsecured email, postal mail, or fax.

Technology Platform Usage Requirements

All documents required for onboarding, accreditation, payer enrollment, compliance review, and related services must be uploaded directly by the Client through TriumpHealth's approved secure technology workflow. Failure to use the approved secure process may result in delays or inability to proceed.

Payer / Portal / System Access

Where payer portals, accreditation portals, NPPES, Medicaid, EHR/EMR, or other third-party system access is required, the Client is responsible for providing timely, accurate, authorized access.

Primary Location Address

The Client confirms that the primary DME location information provided in this form is accurate and suitable for accreditation, payer enrollment, licensing, site-visit, and regulatory requirements.

Scope of Work Precedence

If information in this onboarding checklist conflicts with the executed Service Agreement or Scope of Work, the executed Agreement and Scope of Work will control.

Completion of this form does not guarantee accreditation, payer approval, enrollment, reimbursement, site-visit approval, or any regulatory determination.

Section 13: Attestation

By submitting this form, the organization certifies that the information provided is accurate and complete to the best of its knowledge.

Draw your signature using your mouse, trackpad, or touchscreen.

This onboarding checklist is used to determine business identity, ownership, licensure, payer status, and initial ACHC accreditation readiness.
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