Accushield Registration Guide

Accushield Registration Guide Welcome to Accushield! You are now part of a network of companies with the highest standards of safety and security in the senior living industry. As an Accushield credentialed company, you will have access to serve in all the Accushield partner communities in your area. One or more senior living communities where you do business has contracted Accushield to verify and manage the credentials and visits of all vendors and care providers who work on their property. This guide will show you step by step how to comply with the community s credentialing requirements. You have a 30-day grace period to have the credentials of your company and employees submitted and verified by Accushield. Waiting until after the grace period may result in denied access to the community and/or interruption in service, so if you have any questions or need assistance, please let us know immediately so we can help. 3-Step Registration Process Create account The vendor or care provider creates an account at the Accushield kiosk using their mobile phone number and legal name. Submit documents The employer completes the registration packet and submits all required documents to Accushield via. Receive Confirmation The employer will receive an email from Accushield, confirming that the agency and staff are credentialed or communicating the need for additional information. 800-478-5085

7 Required Submissions Checklist Company Specific Credentials c 1: Agency or Vendor Company Registration Form page 3 c 2: Agency or Vendor Agreement page 5 c 3: Payment Overview page 9 c 4: Certificate of Liability Insurance (COI) Requirements page 10 Individual Specific Credentials c 5: Employment Verification Letter page 12 c 6: Proof of Negative TB page 12 c 7: Criminal Background Check page 13 Communication Tips Submit credentials to. Email is the best way to submit credentials as it is easier to track. If email is not available, you can fax them to (404) 382-7229. Upon sending an email, you will receive a confirmation from FreshDesk (our ticketing system) regarding your submission. To track your submissions, follow the instructions in the FreshDesk confirmation email to create a free account. Visit accushield.freshdesk.com/support/solutions to get more details on credentialing and answers to FAQs. 2

1 Registration Form 3 pages Please fill out ALL fields carefully for accuracy and speed of service (please print). Company Contact for Compliance Name: Title: Phone Number: Fax Number: E-mail: Submitting As: c Corporate Owner (Please attach a list of all branches for which requirements will apply. List each branch location s contact info as illustrated below) c Branch Location c Sole Proprietorship c Franchisee c Franchisor c Staffing Agency Company Branch/Local Office Information Company Name: Address: City: State: Zip Code: Contact Email: Main Phone: Contact Name: Title: Contact Phone: 3

Corporate Office Information (if applicable) Company Name: Address: City: State: Zip Code: Contact Email: Main Phone: Contact Name: Title: Contact Phone: Billing Location Information Company Name: Address: City: State: Zip Code: Contact Email: Main Phone: Contact Name: Title: Contact Phone: c Check to receive invoice electronically Billing Email: If billing is centralized, please attach a list of all your branches with the Branch Name, Branch Address, Company Email, Main Phone, Contact Name & Title, and Contact Phone. 4

List All Accushield Partner Communities in Which You Serve What Service Type Does Your Company Offer? (Check all that Apply) c Doctor c DME c Home Care c Home Health c Hospice c Marketer c Non-Healthcare Other c Nurse/PA c Private Duty Sitter/Provider c Healthcare - Other 5

2 Agency or Vendor Agreement 3 pages This Agency or Vendor Participation Agreement (this Agreement ) is made by the under-signed service provider ( Provider ) for the benefit of Accushield, LLC ( Accushield ) as well as its affiliates and customers, as described below. Provider desires to access the premises of one or more assisted living, independent living, continuing care or skilled nursing communities (each, a Community ) in order to perform certain services, either directly for such Communities or for one or more Community residents. Such Communities have contracted with Accushield to manage their credentialing program and implement risk management and access policies for third-party healthcare providers and other vendors. One or more Communities has directed Provider to register with Accushield for such purpose as a condition to accessing such Community s premises and performing services thereon. In consideration of the foregoing, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Provider hereby agrees as follows: 1. Provider hereby agrees to participate in Accushield s credential management program as described above. Provider has reviewed and completed the registration material available at www.accushield.com and agrees to comply with the terms thereof, including (a) procuring, maintaining and providing evidence of the minimum required insurance coverages, (b) submitting employment, background, immunization and other specified credential information ( Information ) about Provider s employees, sub-providers and independent contractors that will perform services at a Community location (such persons, Personnel ), (c) providing Accushield with updates to the Information as necessary to keep it from being inaccurate and (d) promptly paying the applicable credentialing fees for Provider Personnel, unless the Individual Payment option has been selected on the Registration Form. 2. Provider represents and warrants that it has received all required authorizations necessary to submit to Accushield the Information that it will provide from time to time, including Information relating Provider s Personnel. Provider authorizes Accushield to review such information and relay it to one or more Communities strictly for the purposes described herein, and further authorizes Accushield to obtain additional information regarding its Personnel as necessary to evaluate whether or not such Personnel satisfy the credential criteria established by the Communities. All Information submitted by Provider to Accushield shall, to the best of Provider s knowledge, be true, correct and complete in all material respects. Provider shall comply with all applicable laws in connection with its participation in Accushield s credential management program or with Provider s provision of services at any Community, including, without limitation, all laws relating to data privacy and the protection of healthcare or other confidential or personal information. Without limiting the foregoing, Provider shall not submit to Accushield any social security number, driver license number or protected health information 6

of any of its Personnel, or any other information that may not be disclosed or transferred under applicable law. 3. Provider acknowledges and agrees that, in providing services to any Community resident, directly or through its Personnel, Provider is doing so solely at the request and for the benefit of such resident as an independent contractor thereof and not for or at the request or direction of Accushield or such Community. Similarly, in performing any services directly for a Community, Provider shall do so solely as an independent contractor there- of and not of Accushield. Except for permitting access upon validation of credentials, neither Accushield nor any Community shall be required or permitted to direct in any manner Provider s Personnel or the performance of any of its services. Nothing contained in this Agreement, nor the review and validation of any Information, nor any determination as to whether or not access to a Community shall be granted, shall establish any employee, partnership, agency or joint venture relationship by and among Accushield or such Community on the one hand and Provider or any Personnel on the other hand. 4. Provider, for itself and, to the maximum extent allowed under applicable law, for its Personnel, hereby (a) fully and forever releases Accushield, each Community where Provider or its Personnel may perform any services, and each of their respective affiliates, successors and assigns (collectively, the Released Parties ), from and against any and all losses, damages, claims, demands, lawsuits, expenses, injuries (including death), and other liability of any kind, whether now known or hereafter arising or discovered (collectively, Losses ), that Provider or its Personnel may suffer or incur in connection with or arising out of Accushield s review, validation and handling of the Information, or the performance of Provider s services at the Community s facility or otherwise; and (b) agrees not to initiate any claim, lawsuit, demand, court action or similar proceeding on account of any Losses described in the foregoing clause (a), nor shall Provider or its Personnel join or assist any other party, including insurers (through right of sub-rogation or otherwise) in so doing. The foregoing release and covenant not to sue shall apply in all circumstances, including negligence of a Released Party, excepting only the gross negligence or willful misconduct of a Released Party. 5. In furtherance of each of the foregoing paragraphs, Provider agrees to indemnify and hold Accushield and each Community harmless against any and all Losses suffered or incurred by them as a result of any claim by Provider Personnel or any third party arising out of any act or omission of Provider or its Personnel in connection with the performance (or non-performance) of any service for any Community or resident, including claims by any Personnel that he or she was an employee or agent of Accushield or a Community. The foregoing indemnity shall not apply with respect to any Losses of Accushield or a Community to the extent caused by such party s gross negligence or willful misconduct. 6. Provider acknowledges and agrees that this Agreement is intended to be binding on its Personnel, and Provider agrees to inform and obtain the agreement of its Personnel as to the contents hereof. 7

7. Provider further acknowledges and agrees that each Community for which it may provide any services, together with the other Released Parties, are intended third party beneficiaries of this Agreement and shall be entitled fully to rely upon it. 8. This Agreement: (a) shall be binding upon and inure to the benefit of the parties successors and assigns; (b) contains the entire agreement of the parties relating to the subject matter hereof; provided, however, that this Agreement shall not supersede any existing written agreements between Provider and a Community, and any such existing agreement shall control; and (c) may not be amended except in a writing signed by Provider and Accushield. If any provision of this Agreement is determined by a court of competent jurisdiction to be invalid, such provision shall be modified solely to the extent necessary to make it valid and shall not affect any other provision hereof. BY SIGNING BELOW, THE UNDERSIGNED REPRESENTATIVE OF PROVIDER ACKNOWLEDGES THAT HE OR SHE HAS READ AND UNDERSTOOD ALL OF THE TERMS HEREOF AND THAT PROVIDER IS VOLUNTARILY RELEASING SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. IN WITNESS WHEREOF, Provider has caused this Agreement to be signed as of the date set forth below. Company Name: Signature: Name (please print): Title: Date: 8

3 Payment Overview The Accushield credentialing service includes a fee for the collection, validation and management of your credentials and visit information as required by the community. Accushield will bill your Agency/Company the monthly fee of $9 for each employee or contractor who accessed an Accushield-Partner Community that month. (i.e. if 3 employees or contractors access an Accushield Partner Community in a month, the monthly bill for your Agency/Company would be $27. If only two employees or contractors access the community the following month, that month s bill would be $18). The $9 fee covers unlimited visits to Accushield Partner Communities where the provider meets all credentialing requirements. Agencies can pay online by going to accushield.com and selecting Pay Online. 9

4 Certificate of Liability Insurance (COI) Requirements 2 pages To meet the community s requirements, the commercial general liability insurance and worker s compensation documents must meet the following criteria: Include the name of the insurance company, policy number, and the expiration date. List all DBAs, and/or Subsidiaries, and/or Independent contractors covered under the policy. The name of the company on the policy must match the Accushield account name. Must be updated annually upon expiration. All insurance is required to be written by insurance companies with an A.M. best rating of not less than A-. Commercial General Liability Insurance Limits not less than: $1,000,000 Each Occurrence combined single limit for bodily injury, property damage, and disease per occurrence - and $3,000,000 general aggregate. The above must be written on an occurrence form and must include: Blanket contractual liability Products and completed operations Employees and Independent contractors of the Insured (if applicable) Broad form property damage Personal injury Workers Compensation Insurance (For employees or contractors working for Agencies or Vendor Companies) Policy Limits not less than: $100,000 per occurrence for bodily injury, $100,000 per occurrence for bodily injury by disease, and $500,000 policy limit for bodily injury by disease. Where healthcare providers and/or vendors utilize non-employees for the performance of any services completed at Accushield-Partner Communities, healthcare providers and/or vendors shall do either of the following: 10

a. Declare the remuneration for all work performed by non-employees to its Workers Compensation carrier, and such shall be documented on healthcare provider and/or vendor s Workers Compensation coverage documentation. b. Healthcare providers and/or vendors shall document that all non-employees engaged in such work are covered by Occupational Accident Insurance that compensates them for injuries incurred, including medical expenses, loss of income, and death/dismemberment/paralysis with benefits limits not less than: $500,000 for medical expenses incurred over at least a 104-week period; $25,000 for death with a survivor benefit totaling at least $125,000; and 66% of earnings up to $500 per week for loss of income up to age 65 or older. *Healthcare provider and/or vendor shall provide renewal certificates of insurance at least thirty (30) days prior to the expiration of such policies required below. Such policies may not be adversely changed or canceled without thirty (30) days prior written notice to all Accushield-Partner Communities served by healthcare provider and/or vendor. Healthcare provider and/or vendor shall always comply with all requirements of the insurers issuing said policies. 11

5 Employment Verification The community requires a simple statement on company letterhead that is signed and dated and confirms that each individual is currently employed by your company. For example, "the following individual(s) is/are employed by [company name] and is/are in good standing. This can be emailed to. Multiple employees can be verified on the same document. 6 Proof of Negative TB The community requires annual proof of negative Tuberculosis. Submit a copy for each employee for whom you are providing verification. The proof of negative TB (Tuberculosis SkinTest /PPD, Mantoux,TST) must be from within the past 12 months and meet the following criteria: Must be submitted annually Must include the date of administration and reading of the PPD (The measurement in millimeters of the induration) and Must include the signature or stamp of the MD, DO, RN, APRN, PA, or clinic. In the case of positive test results: o You will need to submit one clear x-ray report (valid for five (5) years). Please do not send actual X-ray. -AND- o a TB Symptom Questionnaire needs to be submitted annually starting after one (1) year of original X-ray. It needs to be signed by a healthcare professional or an employee at your agency who asked the questions. For a sample questionnaire visit accushield.freshdesk.com and click on Solutions. We also accept negative results of Interferon Gamma Release Assay (IGRA) testing. We do not accept the BCG vaccine in lieu of the negative TB test results. 12

7 Criminal Background Check 2 pages The background check for each employee needs to include the following information: 1. National Sex Offender Registry Check. This can be done online for free at www.nsopw.gov. 2. Submit either of the following: Statewide Background Check Statewide check that includes all felonies and misdemeanors from a reputable background check agency, based on a 7-year SSN address history* of the individual. It must include all states in which they have lived during the 7-year period. -OR- County and National Background Checks for All Relevant Counties A background check of all relevant counties* can be sent along with a national background check from a reputable criminal background check agency. All counties in which the individual has lived during the 7-year period must be included. * Any of the above background checks must state in the report that they are based on a SSN 7-Year Address History Trace of the individual. This statement validates that the report is based on a SSN that shows the individual s 7-year address history. If this statement is not provided in the report, a separate Social Security Trace must be completed by a reputable background check company and must include the specific addresses the individual has lived at as well as the dates he/she has lived there. We cannot accept documents that include Social Security Numbers and Driver License Numbers. If any of your documentation includes this information, please redact it before sending it directly to Accushield. In Florida, the Agency for Health Care Administration (AHCA) Background Screening Result form will suffice for the background check requirement. This can be obtained by logging into the ahca.myflorida.com website. In California, the California LiveScan results will suffice for the background check requirement. This can be obtained on the CA.gov website. 13

We will accept a criminal background check from any reputable third-party service, as long as it meets the community standards listed above. If you need an agency to perform a Criminal Background Check for an employee see below for the option of using MLQ Attorney Services. A volume discount has been negotiated with MLQ Attorney Services to conduct an adequate background check. A release form, credit card authorization form, and any state specific documents required for MLQ Background Services are available for download by visiting the credentialing section at accushield.freshdesk.com under the solutions tab. These documents should be submitted directly to MLQ if you choose to use their services. They will run the background check(s) and submit the results directly to Accushield on your behalf. Note: MLQ is unaffiliated with Accushield, and independently operated. For processing and accurate pricing information, please contact MLQ at orders@mlqas.com or call 800-446-8794. 14