1.  Generate a 2744 form on monthly basis

2.  Run the "Transplants Performed" Report. Check the list to make sure the number of transplants and type of transplants           performed are correct.

3.  Pay attention to Dashboard Notifications

4.  Initial 2728 paperwork

          Enter data in CW under patient attributes

          Go to 2728 form and add the form. Complete the form and Save.

          Print 2728 form for signatures (for Medical Doctor and Patient signatures)

          Obtain signatures in blue ink. Send the form to SSA

          Log back in to CW and enter dates on 2728 form.

          Submit 2728 form

5.  Supplemental 2728 Form

          If patient receives a transplant within the first 3 months of first date of dialysis

          This form will entitle the patient to receive benefits from the start of dialysis rather than waiting for 3 month                            coordination period to end

          Click Add supplemental form and complete as above

5.  2746 form

          Complete if a patient dies within 3 years of transplant (Patient is covered under Medicare so need to terminate benefits).  You must enter the Date of Death and Primary Cause of Death under Patient Attributes page in order to view the 2746 link to submit a CMS-2746 form. If you cannot edit a CMS-2746 Form, you may not have a Facility Editor role, OR the form may have already been submitted. Patient will be out of your facility scope after 14 days. If you cannot edit the Patient attributes page after 14 days to enter DOD and COD, email the UPI, DOD and COD to the IPRO support help desk. We will enter that information for you within one day. This triggers the 2746 link in CROWNWeb to add the CMS-2746 Form. Do not fax the 2746 form to the Network.

          Only saved CMS-2746 Forms can be deleted.

          The CMS-2746 Form cannot be edited after submission. You will need to contact the QualityNet Help Desk to make                any changes.

6.  2744 Forms - Centers for Medicare and Medicaid Services (CMS) Annual Facility Survey.  

        Usually asked to be completed and submitted by April 1 of current year for reporting of prior year. Submit 2744 form              for data through December 31st of previous year.

          Generate 2744 form first to populate numbers and data

          Enter data for Field 51 and Field 52: patient’s awaiting transplant that are on dialysis and those that are not

          Run reports on the left to confirm the data

          Save completed 2744 form

          Submit to Network acceptance

7.  Facility Personnel

          All staff changes should be updated and edited in CW within 5 days of staff change

          For all personnel confirm:



          Phone number

          Email address

8.  REDCap – Secured Electronic Data Capture System

          This system was established to give the Transplant Centers the ability to enter data for admissions, the Network will                enter data into CW for the Transplant Centers (at this time, Transplant Centers do not have the ability to                                   admit patients into CW). This reporting can be done upon each admission, weekly, or monthly.

          The Network will send you a link to report patient information via REDCap

          Enter data and information for patients per the fields requested in REDCap

          Submit form

          Once the Transplant Center submits form the Network will receive an alert to review the data

          Please allow the Network 48 hours to enter all data

          Once the Network enters data, the Transplant Center will be able to see the patient in CW