Download Portal Application - Montana

If you are not a current COMPdata analytical tool user, upon receipt of this completed form, we will contact your COMPdata primary user to approve your access to the system. We will notify you when this has been completed.

Facility Name

Facility Address

City

State

ZIP Code

User First Name

User Last Name

Title

Phone Number

E-Mail Address

Enter your business e-mail address to establish a login ID.

Download Portal

Primary – One per account/main account manager General Access – Database User

Replace User

Yes No

If yes, please provide the prior user’s information below.

Prior User First Name

Prior User Last Name

Effective Date

Data

Inpatient Outpatient Both

Select One

I have read and agree

User Account and HIPAA Compliance: Users must maintain a current password to continue system access and/or system-generated reports and other notifications. Passwords expire every 60 days. Email notifications are sent 10 days prior to an accounts deactivation. A primary user is designated for each facility or Health System, in order to manage User accounts. Primary users must contact us immediately of a user’s status change (e.g., separation of employment or duties) and ensure inactive accounts are removed from our system. Official UB-04 Data Specification Manual and Data file, [2020], is copyrighted by American Hospital Association (“AHA”), Chicago, Illinois. No portion of the official UB-04 Manual may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. CPT Copyright 2020 American Medical Association. All rights reserved. Fee Schedules, relative value units, conversion facts and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark or the American Medical Association. U.S. Governmental Rights. This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. The American Medical Association does not agree to license CPT to the Federal Government based on the license in FAR 52.227-14 (Data Rights – General) and DFARS 252.227-7015 (Technical Data – Commercial Items) or any other license provision. The American Medical Association reserves all rights to approve any license with any Federal Agency. Patient Population Dashboards User may not: (a) derive or attempt to derive identifiable information about any individual included within the data set, either alone or in combination with other available information; or (b) identify or contact or attempt to identify or contact any individual included within the data set. Demographic Data Source Demographic data is provided by Claritas, which prohibits: (a) any disclosure or distribution of any portion of the Licensed Materials to any third party; (b) reverse engineering, decompiling, or otherwise decoding of any portion Licensed Materials; (c) distribution, marketing, licensing or selling of any derivative work based on any portion of the Licensed Materials; or (d) use of any portion of the Licensed Materials as a factor in determining an individual’s eligibility for personal credit, insurance, employment or any other purpose for which a consumer report may be used under the Fair Credit Report Act, or in any way that could result in adverse action or disparate treatment under the Equal Credit Opportunity Act.

Download Portal Application - Montana

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