Instructions to Submit a SPARCS Compliance Exception or Extension Request

1. Select ‘Submit a Request’ in the upper right corner of this site.
2. Select ‘SPARCS Compliance Extension Form’ or ‘SPARCS Compliance Exception Form’ from drop down menu.
3. Informational fields should be completed as described below:

Field Description/How to Complete

CC
Enter email address(es) to receive a carbon copy of this compliance exception or extension request.

Select the facility associated with this request. 
Scroll down to select the full six-digit PFI of the facility applicable to the request.

Subject
Enter a brief title for your request. (e.g. PFI 123456 Extension Request)

SPARCS Coordinator/Contact First Name
Enter your name as the facility’s Primary Coordinator, Backup Coordinator, or other authorized SPARCS contact.

SPARCS Coordinator/Contact Title
Enter your title with the facility.

SPARCS Coordinator/Contact Email
Enter your professional email address.
 

SPARCS Coordinator/Contact Phone
Enter your professional phone number.

Should Ambulatory Surgery, Emergency Department, Inpatient, or Outpatient (AS, ED, IP, OP) data be considered in this request? 

Select ‘Yes’ or ‘No’ for all claim types (AS, ED, IP, OP).  

Example shown below.
 

Field Description/How to Complete

Select all months requested for [year] [claim type] data.

If ‘yes’ is selected for a claim type in the preceding question, the months will appear for five active years of SPARCS compliance. Select the applicable months per year for extension or exception request.

Example shown below.

Field Description/How to Complete

Extension or Exception Reason
Select the category that best describes the reason for request.  Add specific details of the reason for exception or extension in Description field.

Extension Period Requested
Select the desired length of time for extension. Add specific submission plan to support the time requested in Description field.

Description
Add specific details to explain the reason for extension or exception request. Extensions also require a plan for submission to describe the submission plan and the expected timeline.

1. Exceptions Only: Check the box to certify that all facility data for the requested periods were submitted to SPARCS, and the number of records accepted is correct.
2. Check the box to certify that there is no Protected Health Information (PHI) included in this request or provided attachments. 
3. Attachments: Click on ‘Choose a File’ to attach any supporting documentation applicable to your request. Do not include any PHI in the attachment.
4. Click ‘Submit’ to complete request.  You will receive a confirmation email with a ticket number for reference.