Welcome Medicount Partners!
As you are aware Medicount and CliniSync are working together to automate the process of collecting demographic information on the patients you transport to CliniSync partner hospitals. By signing with CliniSync for the Medicount Project it allows your third-party biller Medicount to collect demographic details such as name, address, insurance coverage, guarantor, etc. about the patients you transport to CliniSync partner hospitals on your behalf.
Medicount says: “Medicount has been working with CliniSync as well as the contributing hospitals for over 2 years. The hospital systems that contribute to the CliniSync HIE provide you with the patient insurance information for your various transports. To continue operating in this way, Medicount must now formalize their relationship with both CliniSync and the contributing hospital systems. Please fill out the documents as soon as possible so we can continue to receive patient insurance information to process your patient insurance claims.”
To learn more about the Medicount/CliniSync project please click on the link below to review additional information.
Medicount contact: Michelle Hicks | Email: firstname.lastname@example.org | Phone: 513-612-3383
To move forward, please follow these four steps:
1. Please view this video on how to fill out the “Participant Access Agreement (EMS).”
2. Click on the link below to access, download and complete the contract below entitled “Participant Access Agreement (EMS).”
The agreement is a fillable PDF; you will need to save a copy to your computer, enter the necessary details and electronically sign before emailing back to CliniSync. There is no need to print a hard-copy for signing, scanning and/or faxing.
3. Enter your organization’s information at the top of the agreement.
Example: This Participant Access Agreement (the “Agreement”) is entered into and made effective as of the last date of the Parties to sign (the “Effective Date”), by and between Gothum Township Division of Fire (the “Participant”) an Ohio Fire & EMS company , located at 123 Wayne’s Way, Gothum City 19404 and the Ohio Health Information Partnership, Inc., an Ohio nonprofit corporation, located at 3455 Mill Run Drive, Suite 315, Hilliard, Ohio 43026 (“Company”) (each a “Party” and collectively the “Parties”).
4. After reviewing the agreement, complete the signature section at the bottom of Page 4.
5. Submit this completed document to: email@example.com. A CliniSync representative will follow up with the identified contact in three business days.
We look forward to working with you!
Should you want to learn more about CliniSync, click on the information links at the top of this page. If you have any questions or wish to talk with a CliniSync representative, please submit a question to firstname.lastname@example.org or call 614-664-2600.
For any questions please contact:
Michelle Hicks (email@example.com)
Karen Bishop (firstname.lastname@example.org)