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    Services or Offerings?
    Add new user request form for all users in the HHUNY Adult Health Home

    Request to void a finalized billing questionnaire (HML)

    Please use this form if your member requires a CIN Change.

    This form can be used to request a client name change request.

    Deactivate access for user

    Any question(s) that does not fall under one of the services already listed not chart based

    A referral for Medicaid members to receive health home care management services through HHUNY affiliated health homes

    A referral for Medicaid members to receive health home care management services through HHUNY affiliated health homes

    Request access to HHUNY resources outside of New York State for a CMA user

    Used to report any member complaint/issue to HHUNY Compliance

    Reset MFA (including Okta verify) for Netsmart and/or HHUNY Okta (Access to: HHUNY Help Desk, HHUNY Portal, Tableau, & ShareFile)

    Form for voiding any assessment other than HMLs (e.g. Crisis Plans, Eligibility Assessments).
    *This form should NOT be used to request HML voids!

    Miscellaneous questions regarding training

    Submit a request to restore missing data (e.g. notes, HMLs, other assessments) into a chart.

    Training questions on how to use Netsmart system