1. Step-by-Step Provider Instructions for Completing a JCCQAS Electronic Application (E-app)
1 May 2019
For Official Use Only

2. First time JCCQAS users
When your JCCQAS account is created, the system will generate two separate s with your username and password. The username and password can be used to login to JCCQAS and will be valid for 90 days.
Internet browser: Use Chrome if available

3. Internet browser: Use Chrome if available
Return JCCQAS users
Internet browser: Use Chrome if available
Choose one of the options below:
Use a CAC activated computer to log in to JCCQAS. You may purchase a CAC reader and install on your personal computer to gain access to CAC-restricted websites.
Go to click on the “Privileging forms for MFGI/RFX initiative” tab in the upper central portion of the page, download the appropriate hardcopy application, fill out completely, and scan and (or mail) to your credentials office (see slide # 4).
Add AOCs to the QMO page.

4. Instructions/Troubleshooting/ Locked accounts
Points of contact:
Ms. Natosha Edwards
Office: (404)
Cell: (404)
Ms. Terrilyn Walker
Office:
Cell: (404)
Ms. Amy Beverly
Office:
Cell: (404)

5. Logon: Step 1 Go to the following link = https://ccqas.csd.disa.mil
Select “ CAC/ PIV Logon” button ( if you have a CAC card) or “Username Logon” button if you have a username and password.

6. Logon: Step 2
Read DoD ( and VA if applicable) Privacy Act Statement, 1102 Protected Status, HIPAA Warning, etc., then select “Yes, I understand….”
*This is all on one page, but you will have to scroll down to read all required information before clicking selecting “Yes…”; you will automatically be sent to the next page.

7. Logon: Steps 3 and 4
Read the mandatory DoD Notice and Consent Banner and select “OK”
Then, click on “CAC Access”

8. Logon: Step 5

9. Step 6
Select “My Applications”

10. Select “Open” from the drop down
Step 7
You will likely have only one app type on your list. If you have more than one, please select the one that applies to your current circumstances. If you have any question, please contact your credentials office ( see slide # 4 for contact information.
Review with Richard, unsure about what needs to be done, need to be more prescriptive.
Select “Open” from the drop down

11. Instructions
Read the instructions carefully. You must complete each section on the left of the screen before signing (E-signature) and submitting your application.
Select “Next Section”
For any additional questions/issues, you can contact the Credentials Office by clicking on “Contact your Credentials Office”
If this link does not work, contact those identified in slide # 4

12. Profile
All sections denoted with an asterisk (*) are mandatory and must be completed before you will be able to complete the E-Signature.
When all fields are complete, press “Next Slide”

13. When all fields are complete, press “Next Slide”

14. Position
If you are a Physician Assistant or Nurse Practitioner choose Allied Health as your provider category.
For the 3 fields under the Privileging section in the middle of the page, you will choose the following:
Are you requesting privileges at this time?* = YES
Type of Privileges Requested = “Regular”
Type of Appointment Requested = “Affiliate”
Do not check this block. You will not need admitting privileges.
Select the appropriate Hospital/UIC
Select “Next Section”

15. Review
For the following sections, open each tab (and sub-tab where indicated) and review all available information. If any information is incorrect or incomplete, contact the Credentials Office ( To see the link to the Credentials office click instructions in the navigation bar or see slide # 4 of this presentation)
Identification
Contact Information (address, , phone)
License (state, unlicensed information)
Certification/Registration (state, national)
Board Certification
DEA/State CDS
Education and Training (foreign graduate, post graduate)
Specialty
Academic Affiliations
Organizational Memberships
Continuing Education
Contingency/Additional Training

16. Practice History Questionnaire
With both Practice and Health History forms, click “add” to create a new form

17. Practice History Questionnaire
Answer all questions
“Yes” answers require an explanation in Comments
SAVE and you will be automatically sent to the next page

18. Practice History Questionnaire
You will see the updated time stamp and confirmation verifying that you have completed a new questionnaire

19. Health Status Questionnaire
Answer all questions
“Yes” answers require an explanation in Comments
SAVE before moving to next page

20. You will see the updated time stamp and confirmation verifying that you have completed a new questionnaire

21. References
Two references are required for privileging. No more are needed.
If you have no references, you will need to add them
From same specialty peers?

22. References
After entering your reference’s information, do not forget to select “Yes” under ‘Current reference.’ The system default is “No” and must be changed to complete the E-Signature.

23. Work History
Review work history and contact your Credentials Office if there are any discrepancies. Any gaps in employment need to be accounted for and entered as line item in your work history.

24. Malpractice Insurance
Malpractice Insurance is not required while on active duty as you are covered by the Federal Tort Claims Act (FTCA); however, you must complete the Malpractice Insurance section or you will not be able to complete the E-Signature
You will need to either add your malpractice insurance information if you have it or you will need to add “FTCA”

25. Malpractice Insurance
Click yes when asked if you have malpractice insurance.
Click add to add your current malpractice information

26. Malpractice Insurance
In the Insurance/Contractor Name (*) box add your malpractice information or FTCA and SAVE
You will see confirmation in green that your information was successfully saved

27. Privileges: Categories
Select your deployment AOC. Contact your credentialing office (slide 4) if you have questions about your deployment AOC. Select “Itemized”; do NOT select “Core/Supplemental ”
Should we use core supplemental
SAVE before moving to next page!

28. General Guidance
You will see a list with privileges appropriate for your selected AOC. Select your privileges from the available list.
When selecting privileges, select those privileges for which you feel comfortable performing unsupervised. Do not request any privileges “ With Supervision”, supervision will not be available in the deployed environment.
For all other privileges select “Not Requested”
If you need clarification on any item, contact the Credentials Office (slide # 4)
Some of the privileges that are unlikely to be needed in the deployed environment will be listed as not facility supported. Failure to request any of those items is not considered adverse in nature. In the eventuality that you are faced with an emergency and you need to care for a patient in unusual circumstances not covered by your privileges, you are expected to intervene and to do everything possible to save the patient’s life or to prevent injury.

29. Privileges: Age Groups
Select all age groups appropriate to your specialty and experience.
Please select at a minimum young adults and adults.
Then click “Next Section”

30. E-Signature: Step 1 Answer all questions
“NO” answers require an explanation in Comments
Click the “I Agree with the Attestation Statement above” box and click “I Agree”

31. You have now successfully completed the E-application.
If there are any issues with the application, you will be contacted by the Credentials Office with further instructions.