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Guide for Completing the Newest HHS CARES Provider Relief Fund Application

The following is information you will need to complete the HHS CARES Provider Relief Fund application. In the process, you cannot save your work and go back to complete at a later time. Each time you enter, you must start over, so this guide is designed to make this process easier to complete.

First, you will need to register with Optum to start the application. If you do not already have a user ID and password with Optum for this process, you will be prompted to create one. The email you enter should be the one you will use for the entire process as verification emails will be sent to you along the way.


The first section is designed to validate your TIN.

You will need:

  1. Your TIN
  2. Your group NPI number (not your individual if filling out for the group)
  3. Your group NPI number effective date (Note: A change in practice location necessitates a new application and therefore a new effective date.)
  4. A Medicaid License number, or a national license number or certificate number
  5. You will also be asked for basic address and contact information


With this information in hand, the data entry should only take a few minutes. Once you submit this first section, it will take up to a day or so to receive an email that your TIN has been validated. It will then take you to the next phase, entering in the requested financial information. When you click on this, an email will be sent to you with a special password to enter the financial section. If for some reason you do not complete all the information needed on the one-page form, it will not save. However, each time you go back, you will get a new email with a new password to copy and paste into the site. You can do that as often as needed, but below is the required information that should help you complete the form your first time.


Under the revenue section you will need the following:

  1. Total revenue for the year
  2. The fiscal year you chose to use (can be 2017, 2018, or 2019 numbers from your tax return)
  3. The percent of your revenue derived from patient care


The next section is Operating Revenue from Patient Care.

This will include your 2019 and 2020 revenues from the first and second quarter of each year. The data is easy to pull from your software (e.g. - QuickBooks). If you do not have this available, contact your accountant for those numbers. There will be four numbers, first Quarter and second Quarter for each year.


The next section is Operating Expenses from Patient Care.

This is also data from the first and second quarter of both 2019 and 2020. The Department of HHS is looking for any losses due to COVID-19. Most members will find that loss in the 2nd quarter of 2020 when revenue and expenses are compared. However, since most everyone in the state has received either grant money from the HHS in the first 2 phases, Medicare Advancement funds or the PPP, or some combination of all, this is typically recorded as revenue and will make your second Quarter of 2020 look much more profitable than it really was. We are not sure yet if the PPP will be forgiven, or how much will be forgiven even if the loan ends up being a grant. Past money that you received in this manner, including the grant from the SBA (up to $10K) that came with the PPP, is NOT part of the equation. Therefore, in the next section of the application you can attest to this and make a correction.


Supporting Documentation:

Four pieces of additional information will need to be uploaded to the application.

  1. Revenues worksheet: A sales report showing all revenue received to the practice in the second quarter of 2020 (4/1-6/30) works well. Our team converted this file to an excel spread sheet, highlighted, and explained the 5-line items that included the two separate HHS grants, the Medicare Advancement funds, the SBA grant, and the PPP loan. We totaled that amount and deducted it from actual patient earnings to show the real loss in income. When submitting, save that to your documents and upload it in this section.
  2. You will need to upload the Federal Tax form from the year you used for revenue reporting.
  3. Upload the supporting documents to show the numbers for 2019 Q1 and Q2 that you used. This will be from your profit and loss report.
  4. Upload the supporting documents for the 2020 Q1 and Q2 numbers.


Finally, you will need your bank name, routing number, checking account number, and the holder’s name on your bank account. Once this info is all uploaded, you will send and DocuSign the form.


Again, if you start the process and need to exit, no problem, you can start and stop as often as you like, but it will not save it for you.


We hope this helps expedite your application and saves you some time.



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