Network Membership


Facilities may initiate a Membership Agreement below, once the facility has received their National Provider Identification (NPI) number. Please see the steps below to initiate your new facility's Network Membership Agreement. You may download or print your agreement during this process.  Your facility should maintain the executed agreement on-site, in the event surveyors request it.

Opening a New ESRD Facility in New Jersey, Puerto Rico, or the US Virgin Islands

Initiate Membership Agreement

  1. Complete and submit this form to initiate your new facility's Membership Agreement with Network 3.
  2. Obtain access to the following national data systems:
  3. Hang Network 3 Grievance Posters (English or Spanish) in area visible by patients. Contact the Network at qirn3@qualityinsights.org to request additional or larger copies.

After CMS Certification

Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, facilities should email a copy of the letter they receive to the Network at qirn3@qualityinsights.org.

IMPORTANT RESOURCES

Email Tricia Phulchand at the Network office at tphulchand@qualityinsights.org or call Tricia at 609-490-0310, Ext. 2422, with any questions.