Patient Toll-Free Number: 866.651.6272

network membership


Facilities may initiate a Membership Agreement below, once the facility has received their National Provider Identification (NPI) number. Please see the steps below to initiate your new facility's Network Membership Agreement. You may download or print your agreement during this process.  Your facility should maintain the executed agreement on-site, in the event surveyors request it.

Opening a new ESRD Facility in Virginia, West Virginia, Maryland, or District of Columbia


Initiate Membership Agreement

  1. Complete and submit this form to initiate your new facility's Membership Agreement with Network 5
  2. Obtain access to the following national data systems:
  3. Hang Network 5 Grievance Posters (English or Spanish) in area visible by patients. Contact the Network at network5@qualityinsights.org to request additional or larger copies.

After CMS Certification
  1. Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, facilities should email a copy of the letter they receive to the Network at network5@qualityinsights.org.


Important Resources


Conditions for Coverage

Interpretive Guidelines

Grievances

Involuntary Transfers & Discharges

Emergency Preparedness

Network 5 Staff

Email Alison Crittenden at the Network office at acrittenden@qualityinsights.org or call Alison at 804-320-0004, Ext. 2707, with any questions.