Change of ownership management process descriptions. TBD. Change of Ownership Management Step 1 of 5 20% Products(Required) MDS PBJ CORE (Claims) CFS (TX Medicaid) Select AllPlease select the products to include for the transition of ownership. MDS SectionUse the (+) symbol adjacent to the row to add more facilities/users.Provider(Required)CCNProduct Go-Live DateNew NPI #New Facility DBA (Doing Business As)New Facility Legal Name (if applicable)Facility Address Add RemoveMDS Users(Required)Permissions List: 1. Management 2. MDS Submitter 3. Business Office (Medicaid)UsernameNew Email AddressPermissions Add Remove PBJ SectionPBJ Users(Required)CCNProduct Go-Live DateNew NPINew Facility DBA (Doing Business As)New Facility Legal Name (if applicable)Facility Address Add RemovePBJ Users(Required)Permissions List: 1. Management 2. MDS Submitter 3. Business Office (Medicaid)UsernameNew Email AddressPermissions Add Remove CORE (Claims) SectionsCORE Users(Required)CCNProduct Go-Live DateNew NPINew Facility DBA (Doing Business As)New Facility Legal Name (if applicable)Facility Address Add RemoveCFS Users(Required)Permissions List: 1. Management 2. MDS Submitter 3. Business Office (Medicaid)UsernameNew Email AddressPermissions Add Remove CFS (TX Medicaid) SectionCFS Users(Required)CCNProduct Go-Live DateNew NPINew Facility DBA (Doing Business As))New Facility Legal Name (if applicable)Continue Billing Current Medicaid Contract # (Yes or No)Medicaid Contract #Vendor #Facility Address Add RemoveCORE Users(Required)Permissions List: 1. Management 2. MDS Submitter 3. Business Office (Medicaid)UsernameNew Email AddressPermissions Add RemoveNameThis field is for validation purposes and should be left unchanged. Δ
