Step 1: Complete the Practice Site Detail fields below

(*Must be completed)

Note: Choose Medicaid and Medicare only if your practice site was audited for both Medicaid and Medicare and the corrective action plan (CAP) covers all failed standards.

Step 2: Please check the box below that identifies your practice site's Action Plan Status

Corrective Action Plan Status Choose one

Step 3: Please identify your sites Barrier(s) to meeting the Provider Access Standards

Barrier(s) Choose all that apply

Step 4: Please identify the Corrective Action(s) your site has taken to ensure the Access Standards are met

Corrective action(s) Choose all that apply

Step 5: By entering your name and title below you are attesting that your practice site has completed staff training and a practice Self-Assessment to ensure that you meet Highmark Wholecare's Access Standards

Attestation* (Should be completed by an Office Administrator or Corporate compliance)

Step 6: If you wish to UPLOAD documentation related to your Accessibility Corrective Action plan, click the "Upload Documentation" button below

  • No documentation uploaded
  • Attached File: {{file.name}} - [Remove]




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