Report
Instructions
Event Definitions & Business Rules
Facility List Card
Submission Policy
Each month, providers are required to submit a Patient Activity Report (PAR) to the Network Office, listing any patient additions, losses, transfers, etc., in the facility during the preceding month. Patient Activity Reports (PARs) are due in the Network Office by the 10th day of each month (ex. January report is due by February 10th, February report is due by March 10th, etc.). Facilities are required by the Centers for Medicare & Medicaid Services (CMS) to use the form below for submission of their monthly PAR data. If you have any questions regarding the form or event definitions, please contact Jason Robins or Alison Crittenden at the Network Office.
Patient Activity Report (MS Excel)
Patient Activity Report (Adobe PDF)
Additional resources you may find helpful in completing your monthly PAR are also listed below:
Instructions for Completing the PAR (MS Word)
Instructions for Completing the PAR (Adobe PDF)
PAR Event Definitions and Business Rules (MS Word)
PAR Event Definitions and Business Rules (Adobe PDF)
Facility List Card (Adobe PDF) - Listing of Network 5 Providers & their Medicare Provider Numbers
Network 5 PAR Submission Policy
MS Excel format: Right-click on the report, then select "Save Target As" to copy report to your PC; Adobe PDF requires Adobe Acrobat Reader which can be downloaded here for free.
