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Steps to Complete Your BAA:
Business Associate Agreement (BAA) Completion Form: Amniotic membrane portal.
This form is intended for healthcare providers, facilities, and other covered entities that wish to engage in a business relationship with Total Surgical. Before proceeding, you will be asked to review and electronically acknowledge our Business Associate Agreement (BAA), which outlines our mutual responsibilities under HIPAA and applicable privacy regulations.
📄 Download the BAA here , complete it, and then upload your signed copy below.
📄 Click here to review the updated Business Associate Agreement (BAA)
You will then be asked to provide basic information and electronically sign the agreement. Upon submission, a copy will be emailed to you for your records, and you will be redirected to the next required form.
Why required? To verify licensed provider status and unlock provider-only financial pages (pricing, reimbursement, ROI).No NPI? Enter the access code we issued to authorized practice admins. This safeguard helps us protect proprietary and payer-sensitive information, comply with partner distribution policies, and ensure materials are viewed only by qualified professionals. Your NPI/access code is used solely for verification and audit purposes and is never used for billing.
Confidentiality & Pricing Disclaimer Amniotic membranes
By proceeding, I confirm that I am a licensed provider or an authorized representative of a healthcare organization. I agree to maintain the confidentiality of all pricing, reimbursement, and financial information provided by KOSMD Consulting, Inc. This information is proprietary, presented on behalf of KOSMD Consulting’s partner companies, and is intended solely for internal professional use.
Pricing information is for reference only and is subject to change at any time without notice. KOSMD Consulting, Inc. and its affiliates make no guarantees regarding pricing accuracy, payer coverage, or reimbursement. Final pricing will always be confirmed at the time of transaction.
I understand that KOSMD Consulting, Inc. is not liable for any claims, reimbursement outcomes, or decisions made based on the financial data provided.
