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Office of Medicaid Innovation Clinical Review Platform Support
Office of Medicaid Innovation Clinical Review Platform Support
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Support for the Clinical Review Platform (CRP).
Do NOT enter any PHI into this form or attach any documents containing PHI!
Title
A short description to explain the nature of a ticket.
Issue Type
Accessing CRP (new or existing)
Logging in or password issues
Submitting or managing a Prior Authorization
Uploading documents
Managing Admin/Staff access
Other (Please Explain Below)
Accessing CRP (new or existing)
New access request
Onboarding support for new NPI access
Unable to locate NPI in CRP dropdown
I submitted a request but don’t have access
Other access issue (not listed above)
Logging in or password issues
Password reset needed
Account locked
Login error message
Other login issue
Submitting or managing a Prior Authorization
Unable to submit new request for service
Unable to locate an existing Prior Authorization
Unsure how to complete a request
Error message appears
Other Prior Authorization issue
Uploading documents
Unable to upload attachments
File uploads but disappears
Error message during upload
Other upload issue
Managing Admin/Staff access
Add new Admin/Staff
Remove Admin/Staff
Update Admin/Staff email on file
Unsure which role to assign
Other Admin/Staff issue
Issue Impact
Low
Medium
High
Prior Authorization Number
Name of Provider
NPI of Provider
Provider Type
Pathways
Fertility Preservation
Adaptive Behavior Support
Description
The full details of a ticket, including any appropriate circumstances or supplementary information that may aid in resolving it.
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Attachment
File attachments associated with the ticket.
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Yes
Other Fields
Your name
Your first name
Your last name
Your email address
Your phone number
Verification Code