Quality Insights’ Forms & Online Ordering
Please print and return your completed form(s) to Quality Insights of Pennsylvania, 2601 Market Place Street, Suite 320, Harrisburg, PA 17110.
Hospital Initiated Notices of Noncoverage Letters – The Center for Medicare & Medicaid Services (CMS) has provided model letters that can be adapted by a hospital for their specific use. The model letters are available on the CMS Web site.
Hospital Initiated Notices of Noncoverage (HINN) Monthly Report – All hospitals are required to submit monthly reports of their Hospital Initiated Notices of Noncoverage (HINN). Attach your HINN letters to this form before returning it to Quality Insights. PDF or Word
Provider Change of Contact Form – Quality Insights strives to provide you the best service possible. So that we can continue to work with you in the best way possible, please be sure to make sure that your contact information is updated. If you have any changes to your facility's contact persons, please complete the online form. Help Quality Insights keep your information current so that the most appropriate contacts at your facility receive our information and updates. Also available in Word and in PDF form. These may be printed and faxed to Frani Maxwell at 610.688.5276.
Physician’s Acknowledgment Statement Monitoring. PDF or Word
Data Submission Deadlines Chart - This comprehensive chart lists data submission deadlines for now through 2010. It includes HCAHPS, HOP QDRP, Public Reporting and Medical Record Validation deadlines.
Online Ordering – Please visit our online ordering site to view and order our free materials.