AMISYS Advance. Training Calendar and Course Descriptions

Transcription

1 AMISYS Advance Training Calendar and Course Descriptions October 1 December 31, 2014

2 DST Health Solutions Education and AMISYS Advance 4th Qtr 2014 Training Calendar - ANNOUNCING ** ICD-10 Release 6.0 Enhancements Included ** RELEASE 6.4 AA BENEFIT MANAGEMENT CLASS at DSTHS BIRMINGHAM, AL LEARNING CENTER AA R 6.4 BENEFIT MANAGEMENT During this 4th quarter, we are offering RELEASE 6.4 AMISYS Advance Benefit Management subsystem certification class at DST HS Learning site. This Release 6.4 Benefit Management training program includes Health Care Marketplace (HIM) impacts in this subsystem. Minimum class size is six attendees. Register today using the form at the end of this catalog. During this 4th quarter, we are also offering RELEASE 6.0 AMISYS Advance subsystem certification classes at Customer s sites. Client on-site classes also being provided during the 4th Qtr 2014! We are prepared to help you tackle present and future challenges by offering valuable learning experiences as you migrate to and upgrade your release of AMISYS Advance. Release Course Name Date Price per Student October 2014 Rel 6.0 Client On-Site Classes Per Client s Needs November 2014 Rel 6.4 AA R 6.4 Benefit Management Birmingham, AL 11/3 11/7/14 (5 days) Rel 6.0 Client On-Site Classes Per Client s Needs $ December 2014 Rel 6.0 Client On-Site Classes Per Client s Needs Proprietary Information of DST Health Solutions, LLC - 2 -

3 ** AMISYS Advance Training Services ** One-On-One Training Consulting Solution DSTHS training department s most recent solution provides client s individual manager, programmer, or end-user with in-depth personalized consulting to meet their specific AMISYS knowledge/skill gap. This one-on-one training solution includes training/consulting on AA functionality, subsystem interrelationships and/or resource analysis on an as needed basis. This on-site service can include: Training on any of the AMISYS Advance (AA) subsystems using client data Review of current configuration for optimization Evaluating current staff s AA processing & procedures Manager or user one-on-one assistance as needed DSTHS standard Training Consultant hourly rates may apply Client Training Program Review / Assessment This valuable service provides our clients with assistance and resources necessary to ensure your in-house developed training process provides optimal performance results. This on-site service includes the following: People: Review existing Client training curriculum and recommend changes as applicable. Conduct desk side reviews with a mix of front-line staff to offer assistance with efficient navigation. Work with Client training team to create any additional training materials needed. Process: Analyze navigation and productivity related enhancements that may be beneficial to maximize productivity Document and present remediation recommendations based on assessment findings. Ask your Account Executive to set up a consultation session with Larry McClain, Manager Education and Development. Proprietary Information of DST Health Solutions, LLC - 3 -

4 Course Descriptions Benefits Management (5 Days)... 6 Pricing Management (5 Days)... 7 Claims Processing User (4 Days)... 8 AA Basic Navigation (2 days)... 9 Basic Training (10 Days) Membership Configuration/User (5 Days) Provider Configuration/User (4 Days) AMISYS Advance Technical Orientation (5 Days) Billing for the New User (5 days) Billing for the Experienced User (4 days) Claims Payable Configuration/User (4 days) Claims Processing Configuration (3 days) Capitation Payable (4 Days) Generic Claims Audit Interface (3 days) Letters in Correspondence Generator (5 Days) Correspondence Generator ID Cards (3 Days) Indemnity Configuration/User (5 Days) Liability Recovery Configuration/User (5 Days) Medical Management Configuration (5 days) Medical Management User (5 Days) Processing (2 Days) LEARNING CENTER REGISTRATION FORM...27 Proprietary Information of DST Health Solutions, LLC - 4 -

5 The Following Courses Are Available Upon Client Request for On-Site Delivery Proprietary Information of DST Health Solutions, LLC - 5 -

6 Benefits Management (5 Days) This course is designed to provide the decision-making tools and practical skills in order to configure the Benefits Subsystem. Explore the interrelationships between benefits management and other AMISYS Advance subsystems Learn about benefit mapping Define the purpose and practice configuring authorization required qualifiers Define the levels in the benefits hierarchy Create benefits, components, riders and benefit packages Learn about and configure the code sets, tables, switches, and screens required to run the benefits management subsystem Define the six counter tracking methods used by AMISYS Advance Attach counters and keywords to the benefit package hierarchy Map benefits to a claim including setting priorities for similar benefits Explore how the BP-EXPLODE process works and strategies for configuring the subsystem for maximum efficiency Review benefit related inquiry screens Review benefit related reports and learn how to stream jobs and processes in the AMISYS Advance environment *New* Impacts of ICD-10 in the Release 6 version of this class Hands on learning activities reinforce concepts: Use work sheets to diagram benefit package configurations. Examine the results of BP-EXPLODE to identify problems or inefficiencies None Proprietary Information of DST Health Solutions, LLC - 6 -

7 Pricing Management (5 Days) The Pricing Management training course presents concepts and applications that must be mastered in order to take full advantage of the AMISYS Advance Pricing subsystem. Explore the pricing management subsystem and learn pricing-related terminology Learn how claim adjudication prices claims Learn the interrelationships between pricing management and other AMISYS Advance subsystems Explore and configure the required tables, switches, and code sets for pricing management Discuss pay class processing, learn how to set up pay classes, and how they relate to provider affiliations Learn how to configure pay qualifiers and how they relate to pay classes Explore pricing keywords and receive introduction to fee schedules and modifier pricing Review the configuration tables and switches associated with the pricing management subsystem Study pricing arrangements including prompt pay discounts, late claims submission fees, anesthesia pricing, multiple surgery pricing, LOS pricing, bed type pricing, HSS and DRG pricing, COB pricing and late claim interest calculation *New* Impacts of ICD-10 in the Release 6 version of this class Hands on learning activities reinforce concepts. In addition, students will participate in the following interactive segments: Case Studies: Be a part of the configuration team that is responsible for automating all provider contracts and configuring the pricing tables, switches, and code sets necessary to meet business requirement. Successful completion of the Provider Configuration/User courses. Proprietary Information of DST Health Solutions, LLC - 7 -

8 Claims Processing User (4 Days) This course is designed to provide the practical skills needed to perform claims entry in the AMISYS Advance Claims Processing Subsystem. Explore the stages of claims processing Review the interrelationships with other AMISYS Advance subsystems Learn the six steps to claims adjudication Describe status codes and paid flags and how the affect claims processing Learn how to enter hospital, medical, dental and drug claims into the AMISYS Advance claims screens Learn how to search for member or provider information or procedure and diagnosis codes during claims entry Review adjudication and error codes you may see during claims entry Learn how to create remarks for a claim Review batch claim entry Review adjudication and status codes Explore claim and service level re-adjudication Learn adjustment procedures including header and service level adjustments and processing returned checks Establish an extended payment plan Create claim cross-references Learn how to manually pay a claim Review the reports associated with the claims processing subsystem Hands on learning activities reinforce concepts, these include: Claims entry for all claim types Creating claim remarks Re-adjudication and adjustments of claims Creating extended payment plans for orthodontia Cross-referencing claims Manually paying a claim Successful completion of the Claims Processing Configuration Course. Proprietary Information of DST Health Solutions, LLC - 8 -

9 AA Basic Navigation (2 days) This class is designed to promote an understanding of the key concepts of navigating the AMISYS Advance (AA) GUI environment. Overview of the AMISYS Advance environment Explore navigating the AA window components Demonstrate finding, adding, updating and deleting records in AA Review viewing jobs in the AA environment Assist class with navigating AA application Hands on learning activities reinforce concepts, these include: Practice navigating the AA environment Entering records in various AMISYS subsystems Finding data in AA inquiry screens None Proprietary Information of DST Health Solutions, LLC - 9 -

10 Basic Training (10 Days) The Basic AMISYS System Information for Customers training program is designed to expose clients to the AMISYS system. During BASIC training, participants learn about system functionality and integration; considerations/decisions to be made before and during configuration; and most importantly, how to use AMISYS. Learn system fundamentals including: o The multi-option structure of AMISYS o Review of the technical architecture Navigate the AMISYS Advance system by: o Logging on and off of the system o Reviewing commonly used function keys and commands Discuss the components of each of the following subsystems: o Reference and Controls o Membership o Provider o Medical Management o Benefits o Pricing o Claims Processing o Liability Recovery o Claims Payable o Capitation o Billing o Correspondence Generator o Inquiry and Phone Log None Proprietary Information of DST Health Solutions, LLC

11 Membership Configuration/User (5 Days) This course introduces core AMISYS concepts and provides an overview of configuration and use of the membership subsystem. Configuration Learn how membership relates to other AMISYS Advance subsystems Review configuration considerations Explore the membership screen hierarchy Learn about and configure the code sets related to the membership subsystem Discuss the membership configuration tables and switches In addition, students will participate in the following interactive segments: Configuring code sets for group, corporation and division screens learning activity Configuring membership subsystem case study Configuring membership subsystem learning activity User Describe membership key concepts Explore the membership user screens Discuss batch membership processing jobs Describe membership processing reports Review how to stream jobs in the AMISYS Advance Environment Explore membership subsystem inquiry screens and functions Hands on learning activities reinforce concepts. In addition, students will participate in the following interactive segments: Configuring code sets for membership screens Entering members into AMISYS Advance None Proprietary Information of DST Health Solutions, LLC

12 Provider Configuration/User (4 Days) This course introduces core AMISYS Advance concepts and provides an overview on how to configure and use the Provider Subsystem. Review the interrelationships with other AMISYS Advance subsystems Explore provider configuration considerations Review the provider screen hierarchy Explore and configure the tables, switches and code sets that relate to the provider subsystem Learn optional provider configurations including: o Provider audit reporting o Provider on the fly o Auto assignment of providers o Affiliation selection criteria o Auto PCP pool assignment Learn how to configure provider credentialing Explore and use the provider and provider credentialing user screens Learn about provider reports and how to run provider reports and processes in the AMISYS Advance environment Review provider error messages Explore common inquiry functions in the provider subsystem Hands on learning activities reinforce concepts. None Proprietary Information of DST Health Solutions, LLC

13 AMISYS Advance Technical Orientation (5 Days) The purpose of this course is to provide a foundation in the AMISYS Advance. Through lecture and hands-on activities, participants will become familiar with many of the software layers and utilities that make up the product. AMISYS Advance Architecture: Discuss the AMISYS Advance architecture and layers that make up the product. Working in the UNIX Environment: logging on and off the system, using the command line, using the online manual, and practicing a few basic commands. UNIX File System and Directory Structure: here we discuss the UNIX file system, UNIX files, path names and the AMISYS Advance directory structure UNIX File Commands: learn commands to display directories and files and work with directories and files on the UNIX system. We will talk about file redirection, and piping. This session includes a group exercise and then concludes with a talk about file characteristics, permissions and access rights. POSIX Shell Features: Learn about POSIX shell features and commands including how to locate commands, how to create a command alias, and view the command history stack. Variables and Commands: Learn how variables work in UNIX, how to recognize UNIX Variables and environment variables and shell variables. The Login Process: We ll take a look at the login process, look at your profile and talk about (and show you) what happens when you login to the system. We will look at the AMISYS Advance Environments we have set up at AMISYS. UNIX Utilities: Learn the basics of GREP and then a quick discussion of regular expressions and using the WC utility. VI: Use the VI text editor to manipulate text (if used at your location). Jobs and Job Files: Discuss job files and where they are stored on the system. We will review the job processing stages (report generation) and streaming a job in the AMISYS Advance Environment. You will learn UNIX commands in order to list, view and print jobs. We will run a job, take a look at the files that are created and read a $STDLIST together. Oracle: Discussion on the Oracle relational database environment, database tables, and the AMISYS Advance database tables. We have also provided you with an alphabetical listing of the AMISYS Advance tables. SQL: This session includes: Access SQL and typing commands; display table structure, query, sort and filter data, saving and exporting queries, using wildcards, calculated fields, functions, grouping data, sub-queries, joining tables, combining queries, inserting, update, and deleting data, creating temporary tables, using views, and SQL scripts Hands on learning activities and independent studies reinforce concepts. None Proprietary Information of DST Health Solutions, LLC

14 Billing for the New User (5 days) This course is designed to promote an understanding of the Billing and Accounts Receivable Subsystem and provides you with the tools needed to configure and use it. Configuring the billing and accounts receivable subsystem for a standard bill which includes configuring: Reports and invoices Code sets PIPE Related membership screens such as group, contract, and premium key Period table billing, age factor tables, unit, account and project definitions and standard switches and tables Using the system to: Produce the invoices and reports Enter premium rates Apply cash both on-line and batch Make manual and system adjustments View the billing screens in membership View the inquiry screens such as Receipt Inquiry, Invoice Detail Inquiry and Adjustment Inquiry screen Hands on learning activities reinforce concepts by using the system to: Produce the invoices Apply cash Successful completion of the Membership Configuration course. Proprietary Information of DST Health Solutions, LLC

15 Billing for the Experienced User (4 days) This course is designed for those with some experience with the Billing and Accounts Receivable subsystem. During this 4 day course students will explore and configure cash by rider, electronic funds transfer, split billing and the lockbox application screens. Review how the billing and accounts receivable subsystem works Review configuration considerations Review running premium billing Configure the code sets, super-tables and switches necessary to run cash by rider Learn how to apply cash on the online cash application receipt by rider screen. Explore the invoice maintenance screen Configure the super-tables, number generators, and bank information necessary for electronic funds transfer (EFT) Change membership bank information records Explore the steps and then run EFT Learn how to terminate an EFT withdrawal Configure the system for split billing Explore lockbox and the lockbox application screens Hands on learning activities reinforce concepts. In addition, students will participate in the following interactive segments: Configure the system to run cash by rider Use the system to enter cash with cash by rider configured Configure the system to use EFT Successful completion of the Billing for the New User course. Proprietary Information of DST Health Solutions, LLC

16 Claims Payable Configuration/User (4 days) This course introduces core AMISYS Advance concepts and provides an overview of the configuration and use of the Claims Payable Subsystem. Learn how claims payable relates to other AMISYS Advance subsystems Diagram the claims adjudication process Explore claims payable configuration considerations Discuss and configure the tables, switches and code sets as related to the claims payable subsystem Explain the general ledger chart of accounts Learn about claims payable user and claims payable check processes Review reporting capabilities and learn how to stream jobs and processes in the AMISYS Advance environment Hands on learning activities reinforce concepts. In addition, students will participate in the following interactive segments: Configuring claims payable subsystem case study PIPE configuration learning activity Defining claims payable expenses group exercise Running claims payable subsystem case study Claims payable review learning activity Check writer learning activity Check consolidation learning activity General ledger postings before and after check writer learning activity EOP report amounts learning activity None Proprietary Information of DST Health Solutions, LLC

17 Claims Processing Configuration (3 days) This course is designed to promote an understanding of the AMISYS Advance Claims Processing Subsystem and provides you with the tools needed to configure subsystem. Review the function of the AMISYS Advance Claims Processing Subsystem Explore the stages of claims processing Discuss the interrelationships with other AMISYS Advance subsystems Explore the six steps to claims adjudication Discuss status codes and paid flags Discuss how to avoid pitfalls during claims processing configuration Learn about and configure required and optional code sets for the claims processing subsystem Configure global switches required for the claims processing subsystem Configure for late claim submission Configure the switch table and affiliation selection criteria Discuss and configure the tables and switches necessary for UB92 processing Configure duplicate service definitions for online claims processing Configure the code sets so that remarks may be added to claims Configure membership eligibility status for claims processing Configure for batch claims processing Explore procedure and diagnosis details Set the table numbers on the main default table Configuring number generators Configure for dental claims processing Learn about error messages and how to find them Hands on learning activities reinforce concepts. In addition, participate as a member of a mock configuration team that is responsible for making sure that the claims processing subsystem configuration meets your organization s business requirements. None Proprietary Information of DST Health Solutions, LLC

18 Capitation Payable (4 Days) This course teaches you how to configure the AMISYS Advance Capitation Subsystem to meet your health organization s needs. Provide a general overview of capitation Explore the interrelationships between capitation payable and other AMISYS Advance subsystems Explore configuration considerations Discuss and configure the tables, switches and code sets necessary for setting up capitation Discuss general ledger and bank code entries Learn how to set up PCP+ and specialty capitation Configure capitation funds Configure capitation rates including how to use age factors and the capitation rate factors Review the capitation related fields on the provider financial affiliation screen Learn how to set up PIPE in capitation Explore how to run the capitation payable extract and how to run reports and processes in the AMISYS Advance system Describe the capitation payable reports Explore how to run the capitation payable post and unlock jobs Learn how to run check writer and check register for capitation payable Hands on learning activities reinforce concepts. In addition, students will participate in the following interactive segments: Case study: configuring capitation payable using PCP capitation Case study: configuring capitation payable using specialty capitation Successful completion of the Membership Configuration/User course. Proprietary Information of DST Health Solutions, LLC

19 Generic Claims Audit Interface (3 days) This course has been designed to give you the decision-making tools and practical skills you will need to configure the AMISYS Advance Generic Claims Audit Interface. Review core AMISYS Advance concepts Explore the AMISYS Advance interface to Third Party Pricing tools Participate in discussion and learning activities that explore the steps needed to configure the AMISYS Advance Generic Claims Audit Interface Complete a configuration scenario Explore how claims are processed through the Generic Claims Audit Interface Learn how to interpret the output of results through Generic Claims Audit Interface Learn how to reverse results if Third Party Pricing does not price properly Participate in claims processing scenarios Discuss batch processing jobs Discuss data transfer contents Oracle database impacts Discuss reporting including the third party savings and AMISYS savings history reports Hands on learning activities reinforce concepts. None Proprietary Information of DST Health Solutions, LLC

20 Letters in Correspondence Generator (5 Days) This course has been designed to give you the decision-making tools and practical skills you will need to use the AMISYS Advance Correspondence Generator Subsystem. Introduction to correspondence generation, terms and definitions Explore the interrelationships between correspondence generator and other AMISYS Advance subsystems Discuss general configuration considerations Explain and configure the code sets, tables and switches as related to the correspondence generator subsystem Explore valid data items, the valid data items report, and configuring self-defined data items Explore and build letters, including imbedded text parameters, data sensitive text variables, user-defined imbedded text parameters, and letter text groups Work with the Microsoft Word interface Discuss letter generation process Learn how letters are triggered, code driven letters, batch jobs that trigger letters and manual letter selection Discuss follow-up letters, including conditional follow-up letters Explore batch jobs as related to correspondence generation Hands on learning activities reinforce concepts. None Proprietary Information of DST Health Solutions, LLC

21 Correspondence Generator ID Cards (3 Days) This class is designed to promote an understanding of the configuration and creation of membership identification cards in the AMISYS Advance environment. Overview of Membership ID Cards Configuration of ID Cards Valid Data Items Creating ID Cards Explain and configure the code sets, tables and switches as related to the ID Cards Microsoft Word Triggering ID Cards Processing ID Cards Combining ID Cards with Member letters Learning Activities: Creating ID Cards for Different Scenarios Hands on learning activities reinforce concepts. Basic Letters in Correspondence Generator Proprietary Information of DST Health Solutions, LLC

22 Indemnity Configuration/User (5 Days) This class is designed to promote an understanding of the key concepts of the Indemnity Billing Manager and provide you with the tools needed to use the Indemnity Billing Manager. Configuration Indemnity Code Sets o Division screen (ME0300) code sets o Hands on Exercise o Premium Rates (ME0400) code sets o Hands on Exercise o Coverage Formulas (ME0500) Overview o Contract Screen (ME1600) code sets Tables and Switches o Membership Global Switches 3 (RF0322) o Billing Switches Table (RF0118) o Main Default Table (RF0102) o Age Factor Table (RF0128) o Premium Key Definition (RF0119) o The Coverage Formula Overview o Other Coverage Key o BACOLUMN Super Table o BA-Column-Table# Super Table o Security User Indemnity Screen Processing Corporation, Group, and Divisions Hands on Exercise Enter Group/Divisions Indemnity Screen Processing Premium Rates Hands on Exercise Premium Rates Indemnity Screen Processing Coverage Formulas Hands on Exercise Coverage Formulas Indemnity Screen Processing Contracts, Members, Other Coverage Formulas Hands On Exercise Contracts with Other Coverage Indemnity Related Error Messages Common Inquiry Functions Hands on learning activities reinforce concepts. Membership and Billing for the New User Proprietary Information of DST Health Solutions, LLC

23 Liability Recovery Configuration/User (5 Days) This class is designed to promote an understanding of the key concepts of Liability Recovery (LR), including coordination of benefits (COB) and credit banking. Learn the hierarchy and use of the Liability Recovery Subsystem screens Explore the interrelationships and dependencies of LR on other AMISYS subsystems Configuring the related codes, switches and tables necessary for running LR Enter alternate coverage information Discuss investigation and tracking of claims for coordination of benefits Examine claims that have been pended for the investigation/diversion process Learn how to send LR related correspondence and initiate LR follow-up actions Learn how to freeze claims against further processing Examine how to associate third party payments (TPP) with specific carriers Hands on learning activities reinforce concepts. None Proprietary Information of DST Health Solutions, LLC

24 Medical Management Configuration (5 days) This course provides the practical skills needed to configure the applications and processes of the Medical Management Subsystem. Learn about the hierarchy of the medical management subsystem Review the interrelationships with other AMISYS Advance subsystems Discuss how authorizations match to claims Discuss and configure authorization code sets Learn about and configure authorization required qualifiers Discuss auto authorization Explore date matching processing logic Configure the tables and switches required for authorization processing Learn about and configure the code sets, tables and switches required each of the following medical management applications: Authorizations (header and detail screens) Concurrent and physician review Discharge summary Authorization intake Alternate opinion processing Medical appropriateness processing Recommendations Case management Quality improvement, and Appeals Review DRG group interface and batch load processing Configure remarks for the medical management applications Hands on learning activities reinforce concepts. In addition, participate in the authorization code set configuration group study and then work on your own to complete the authorization tables and switches configuration case study None Proprietary Information of DST Health Solutions, LLC

25 Medical Management User (5 Days) This course provides the practical skills needed to efficiently run the applications and processes of the Medical Management Subsystem. Learn about the hierarchy of the medical management subsystem Review the interrelationships with other AMISYS Advance subsystems Explore authorization screen processing: o create authorization certification records and o add hospital, medical or outpatient detail records Investigate medical management processing logic Explore the following processes o discuss authorization intake procedures o length of stay processing o alternate opinion processing o medical appropriateness processing Learn about the Diagnosis-Related Groups (DRG) Grouper interface Learn how to authorize prescriptions Perform discharge planning and case management Explore the quality improvement screens Review the appeals process Learn about the recommendation process and recommendation log screen Review medical management reports and learn how to run reports and processes in the AMISYS Advance environment Learn to use common inquiry functions in the medical management subsystem Hands on learning activities reinforce concepts. Successful completion of the Medical Management Configuration course. Proprietary Information of DST Health Solutions, LLC

26 1099 Processing (2 Days) This course has been designed to give you the decision-making tools and practical skills you will need to use the 1099 Subsystem Processing Subsystem Overview Review the interrelationships with other AMISYS Advance subsystems Review Federal Filing Requirements Learn common 1099 Processing Acronyms Review acceptable Media for 1099-MISC Submissions IRS Forms and Publications Importance of the CHECK_X Data Table Check Status Check Types Statistical Checks EOP Negative Balance Non-Consolidated Checks Consolidated Checks Data Linkage Between Data Tables Learn how AMISYS Advance Selects IRS #s for Providers and how AMISYS Advance Uses IRS #s to Produce 1099-MISCs Review Configuration Decisions First Steps Configure the Provider Category (PR) Code Set Learn about and configure the 1099 Parameters (FS0700) screen Set 1099 Configuration Switches (FS0705) Configure the Transmitter Control Code (TCC) received from the IRS. Configure payer information used for 1099 tape processing and coupon generation Learn to group business segments or bank codes together under one payer and multiple TCCs under a single payer tax identification number (TIN) Review which 1099 Processing screens produce reports and why it is important to run the jobs and reports in the order in which they appear on the 1099 Processing (FS0800) screen o Read a Check for Invalid IRS Numbers (FRS0810) report o Determine why the IRS numbers listed are invalid o Learn which screens can be used to correct invalid IRS or Social Security numbers o Learn how to run reports and processes in the AMISYS Advance environment Take hands on look at the AMISYS Advance data tables. o Use SQL to view table entries and select columns from AMISYS Advance tables. Hands on learning activities reinforce concepts. Successful completion of the Provider and Claims Payable courses. Proprietary Information of DST Health Solutions, LLC

27 LEARNING CENTER REGISTRATION FORM To register by fax, complete this form and send it to DST Education and Development Manager: DST Health Solutions Attn: Larry McClain Fax: (205) Registration deadline is ten (10) business days prior to start date of class. Confirmation of enrollment will arrive shortly via . Please enroll one student per registration form. If you have any questions, please contact your Account Executive OR our Education and Development Manager. STUDENT INFORMATION (please print) Please fill in all information completely. Missing information may result in registration delays. TODAY S DATE: / / STUDENT NAME: COMPANY NAME: DEPARTMENT: MAILING ADDRESS: CITY: STATE: ZIP CODE: - WORK PHONE: / - FAX: / - ADDRESS: REGISTRATION INFORMATION CLASS TITLE: DATE OFFERED: from / / to / / COST OF CLASS (as listed on Training Schedule): LIST ANY SPECIAL REQUESTS: Approval Signature (Required): Date: / / Approval Name (Please Print): Title: Approver s Approver s Phone: HOTEL AND DRIVING DIRECTIONS WILL BE PROVIDED WITH REGISTRATION CONFIRMATION DST Health Solutions LEARNING CENTER USE ONLY Date Received: / / Date Confirmed: / / Work Order Number: Date Invoice Approved: / / Department: Cost Center: Proprietary Information of DST Health Solutions, LLC