Health System User Application

This specialized form for health system users ensures all hospitals in your system have access to our data submission platform. Please complete this form to obtain a COMPdata ID.

Users are expected to submit complete, error-free data each quarter using COMPdata’s secure electronic file transfer systems. Be sure to review your data collection feedback reports, correct rejected records and resubmit to COMPdata. Contact us at customerservice@team-iha.org or 866-262-6222 with any questions.

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.

Health System or Group Name

City

State

ZIP code

User’s First Name

User’s Last Name

Title

Phone Number

Enter your business email address to establish a login ID.

Choose a User Type

Primary - One per account/main account manager Secondary - One per account, backup to primary General Access

Replacing User

Yes No Prior user unknown

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

Prior User’s First Name

Prior User’s Last Name

Effective Date

Associated Facilities

Please list all facilities within the health system you are authorized to be associated with for Data Submission Services.

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 90 days. Email notifications are sent 10 days prior to an accounts deactivation. A primary user is designated for each facility 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. The COMPdata Data Submission System contains PHI. Sharing of IDs and password of your personal account are strictly prohibited. Submission of PHI to COMPdata via email must be done through a secure email system with encryption. Failure to do so will result in legal action taken against you to the full extent of the HIPAA compliance act and IHA's legal department.

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Health System User Application

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