
Promoting and facilitating high quality care standards for dialysis and kidney transplant patients
in Iowa, Kansas, Missouri and Nebraska.
Main phone (816) 880-9990
Patient toll free (800) 444-9965
Main fax (816) 880-9088
Data fax (816) 880-1775
7306 NW Tiffany Springs Pky. Suite 230 Kansas City, MO 64153
If you are currently using CROWNWeb you will not need the information below. CROWNWeb is programmed to not allow invalid 2728 or 2746 forms to be created and submitted. Additionally, CROWNWeb users should not use the PAR (Patient Activity Report). If you are NOT using CROWNWeb, the information below is critical for correct submission of patient information.
Target Audience: Dialysis staff responsible for filling out CMS Eligibility or Death Notices, and monthly PARs (Patient Activity Reports)
These instructions are intended to help you successfully understand the CMS 2728 Eligibility Form, the CMS 2746 Death Form, and the Patient Activity Report.
If the instructions are unclear or omit specific information, please contact Serena Timko at 816-880-1707 for assistance.
Please remember that submitting forms with missing or inaccurate information will count against your facility's Forms Compliance Score that is measured every January and July.