PEPPER Resources Portal
Please complete the following fields to access your PEPPER. A provider’s PEPPER is only available to
that individual provider’s Chief Executive Officer, President, Administrator or Compliance Officer.
Corporate Office and/or facility management companies seeking access to PEPPERs for all
member organizations will need to coordinate with each individual provider to obtain their PEPPER.
TMF Health Quality Institute is committed to ensuring and maintaining the confidentiality of each provider’s PEPPER.
Likewise, all recipients of PEPPER are expected to maintain and safeguard the confidentiality of privileged data or information.
I certify that I am the
of this health care provider and further certify that I have the actual authority to receive PEPPER and all other confidential information concerning this health care provider. If a provider does not have a management position with any of these titles, the person who has the authority to make decisions on behalf of the organization should check the box for the title that best describes their position.
Provider State / Territory
Skilled Nursing Facility
Inpatient Rehabilitation Facility
Partial Hospitalization Program
Long-term Acute Care Hospital
Home Health Agency
CMS certification number
(also referred to as Provider Number or PTAN)
Enter either a Patient Control Number *or* a Medical Record Number (found at form locators 03a or 03b on the UB04 claim form) from a claim of a traditional fee-for-service Medicare beneficiary who received services during the specified time period (“from” or “through” date between July 1-Sep. 30, 2016 for providers except HHAs and PHPs; between Dec. 1-31, 2015 for HHAs and PHPs).
(Patient Control Number or Medical Record Number)