Sign-up for TCPi
By completing the registration below you are demonstrating your practice's commitment to participate in the Colorado Practice Transformation Network, (CO PTN) a part of the national Transforming Clinical Practices Initiative (TCPi). Please note that all completed registrations will be reviewed by the TCPI team, who will contact you within 5 business days to identify next steps. Thank you for your interest in participating in the Colorado PTN, a part of TCPI.
Saving Work & Continuing Later:
If you want to stop and return to the application later, simply scroll to the bottom of the page, and click on "Save & Return Later". The system will provide you a "Return Code" that you need to write down and save, as you will be required to enter the "Return Code" in order return to the appropriate application. After you are given the "Return Code" you will be asked to input an e-mail address to which a link will be sent in order to return to your application.
Return codes can also be sent to other members of the practice if necessary by contacting: TCPI@ucdenver.edu or calling the Colorado PTN practice support line at 303-724-8968.
Questions:
If you have questions, please consult the TCPI webpage listed below to submit questions, to register for the next webinar or access the frequently asked questions. This information is posted on the University of Colorado's Practice Transformation website:
TCPI website - click here You may also send questions to TCPI@ucdenver.edu or call 303-724-8968. All questions that are asked will be included with responses in written form in the Frequently Asked Questions (FAQs), which will be updated at least weekly.
1. Please enter your full practice name:
* must provide value
2. How did you hear about TCPi?
* must provide value
3. Practice's address (Street address)
* must provide value
5. Practice's phone number
* must provide value
6. Practice's city
* must provide value
7. Is the practice located in Colorado?
* must provide value
Yes
No
8. In which state is your practice (if not CO)?
9. Please enter the Zip Code+4 of the practice.
If you do not know the +4 digits, please use the USPS lookup at https://www.usps.com/zip4/
* must provide value
10. Please list your practice's website, if applicable
11. Lead clinical provider's full name and credentials
* must provide value
12. Lead clinical provider's email address
13. Person whom we should contact regarding health information technology (HIT) or electronic health records (EHR)
* must provide value
14. Lead HIT/EHR contact's email address
15. Contact person (Please enter their full name) for communication regarding the TCPI Program
* must provide value
16. TCPI program contact's email address
* must provide value
17. Number (not FTE) of clinicians (MD, DO, PA, or APN), LCSWs, or Psychologists
* must provide value
18. What is your patient population? (number)
* must provide value
19. Please provide your Federal Tax ID number
* must provide value
20. Please provide the CCN (if applicable)
21. Please provide the group national provider identifier(s) (NPI)
* must provide value
22. Are there multiple practice sites?
* must provide value
Yes
No
23. Is your practice part of a health system?
* must provide value
Yes
No
What is the name of the corporate, affiliate health system, organization or community mental health center?
Central Administration Street Address
Central Administration Street Number
Central Administration State
Central Administration Zip
Central Administration Phone Number
Central Administration Point of Contact - Full Name
Central Administration Point of Contact - Phone
Central Administration Point of Contact - Email Address
24. Is your practice: primary care, specialty, both (primary and specialty), or a behavioral health provider?
* must provide value
Primary Care
Specialty Care
Both (Primary & Specialty)
behavioral health provider
25. Which of the following describes your primary care type? (Check all that apply):
26. Please specify what other primary care your practice provides?
27. Please enter what specialty or specialities your practice provides?
28. Which of the following describes your practice's ownership? (Choose all that apply)
* must provide value
29. Please describe the practice's other type of ownership.
30. How would you describe your community?
* must provide value
Urban
Rural
Approximate percentage of Medicare
* must provide value
Approximate percentage of Medicaid
* must provide value
Approximate percentage of CHIP
* must provide value
Approximate percentage of Commercial Insurance
* must provide value
Approximate percentage with no insurance
* must provide value
Approximate percentage with other category of payer
* must provide value
Total percentage of payer categories=
View equation
32. Does your practice participate in non-fee-for-service payments from a payer (e.g. Medicare shared savings (ACO), PMPM, global payments, Medicaid BHO, bundled payments, or other alternative payment models)? If yes, please describe below.
* must provide value
Yes
No
34. Is your practice currently participating in SIM (the State Innovation Model)?
* must provide value
Yes
No
35. Is your practice currently participating in CPCI?
* must provide value
Yes
No
36. Do you serve medically underserved populations based on the following criteria?
* must provide value
37. Does your practice use an electronic health record (EHR) system or electronic medical record (EMR) system? Do not include billing record systems.
* must provide value
Yes, all electronic
Yes, part paper and part electronic
No
38. What is the name of your current EHR/EMR system? (choose one)
All Scripts
AdvancedMD
Amazing charts
Athenahealth
Care360
Cerner
eClinicalWorks
e-MDs
EPIC
GE/Centricity
Greenway Medical
McKesson/Practice Partner
NextGen
Practice Fusion
Sage/Vitera
SOAPware
Other
39. Please specify other EHR/EMR system.
40. Is your current system certified to meet Meaningful Use as defined by Health and Human Services / ONC?
Yes
No
Don't know
41. Have your providers participated in Meaningful Use?
Yes
No
Don't know
MU Stage 1
MU Stage 2
43. Is your practice connected to a Health Information Exchange(HIE) such as CORHIO or QHN?
Yes
No
CORHIO
QHN
Other
45. Please specify other HIE.
47. I have more than 20 clinicians' information I need to enter, or I would prefer to submit it via an external Excel document. If no, you will be able to enter the information online below.
* must provide value
Yes
No
Please complete and upload the Excel document (TCPIEligiblePhysicianTemplate) with the following information for each eligible clinician:
Practice Name
Clinician First Name
Clinician Last Name
Clinician's FTE at practice
Clinician TIN
Clinician NPI
Eligible Professional (EP) Type
Primary care or specialty type
Group NPI
Provider HPTC Code(s)
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9.Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
1. Clinician's First Name--20 max�
3. Clinician's FTE at practice (example 0.75)
6. Please provide one or more assigned provider specialty taxonomy (Healthcare Provider Taxonomy Code- HPTC).
7. Eligible Professional (EP) Type
MD
DO
APN
PA
NP
CNS
CRNA
CNM
LCSW
Psychologist
Other
8. Please Specify the other Eligible Professional Type:
9. Primary Care or Specialty Type
10. Do you have another Eligible Professional (EP) to enter?
Yes
No
Please complete and upload the Excel document (TCPIEligiblePhysicianTemplate) with the following information for each eligible clinician:
Practice Name
Clinician First Name
Clinician Last Name
Clinician's FTE at practice
Clinician TIN
Clinician NPI
Eligible Professional (EP) Type
Primary care or specialty type
Group NPI
Provider HPTC Code(s)
By clicking agree and signing this registration, to be considered for participation in TCPI, we commit to the program requirements listed below: As participants in the Colorado TCPI Program, my practice will comply with the following program requirements:
1. Participate in a baseline practice assessment with Colorado TCPI practice transformation organization (PTO) contractors
2. Develop a practice improvement plan for your practice, to be updated as appropriate
3. Commit to improving care and pursuing a culture of safety and accountability at your practice
4. Work with the Colorado TCPI practice transformation organization staff members to develop a plan and strategies to meet your practice aims
5. Identify a lead clinician and staff member for each practice site to serve as practice champions in TCPI activities, with a one-day training session for the practice champions
6. Participate in Colorado PTN learning activities:
a. Learning networks of approximately 10-12 practices, with monthly virtual meetings of practice champions,
b. One to two collaborative learning sessions per year
c. Occasional webinars
d. Related educational events
7. Share your experience and best practices with other TCPI participants, including working with primary care, specialist, and behavioral health practice peers within your medical neighborhood
8. Participate in the CMS Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier programs, if eligible
9. Work with PTO contractors to develop system for reporting selected process and outcome measures as appropriate for provider specialty quarterly.
10. Be in compliance with CMS claims reporting requirements for ICD-10
11. Inform your PTO contractor or the Department of Family Medicine at the School of Medicine at the University of Colorado if your practice or any of its clinicians begin participating in a Medicare, Medicaid or CHIP value-based payment program or other similar alternative payment model
12. Participate in only one Transforming Clinical Practice Initiative Practice Transformation Network
13. Complete the practice assessment within 30 days of receiving it
* must provide value
Agree
Disagree
Who completed this registration? (Please provider your name and role in the practice)
* must provide value
Sign your name with your mouse or finger here:
* must provide value
Submit
Save & Return Later