Provider Access Audit Corrective Action Plan (CAP) Form

Step 1: *Practice Site Details

Enter Practice Site Details in the fields provided.

Accessibility Corrective Action Plan

Step 2: *Action Plan Status

Select Action Plan Status by checking the appropriate box.

Step 3: *Barriers to Meeting Access Standards

Identify barriers your site faces in meeting Provider Access Standards.

Step 4: *Corrective Actions Implemented

List corrective action(s) your site has implemented to ensure compliace with Provider Access Standards.

Step 5: *Attestation of Training and Self-Assessment

Attestation Completion: By entering your name and title below, you are attesting that your practice site has completed staff training and a practice self-assessment to ensure that you meet Highmark Wholecare's Access Standards.

*Attestation should be completed by an office administrator or corporate compliance.