Advance Practice Provider Reimbursement Forms

February 2017

Dear Advance Practice Provider,

Effective January 1, 2017, Full-time and Part-time Advance Practice Providers will again be eligible to receive up to $500.00 in reimbursements for expenses incurred in obtaining CME/CEU credits earned. Per Diem Advance Practice Providers are eligible to receive up to $250.00 in reimbursements per year. All forms, receipts, expense reports and CME/CEU certificates must be received in the Labor Relations office by the deadline of December 31, 2017, in order to receive payment for expenses incurred during the 2017 calendar year. The 2017 forms are also available online at: www.ambulatorypractice.org.

There are three (3) documents that are required when submitting your requests (all three documents must be received by the committee in order to be approved):

1. 2017 REQUEST FOR CME/CEU REIMBURSEMENT FORM
   This one page form is to be filled out completely and as neatly as possible with your employee information. Your signature approval and your Employee ID Number (effective 8/13/05) are required (your employee ID number begins with two zeroes: 00######. It is on your paycheck.)
2. EXPENSE REPORT FORM
   The one page Expense Report Form must be as detailed as possible, explaining each separate cost in the appropriate category (must include travel expenses). You must attach all original receipts. Make sure to sign and date the expense report form. Your manager’s signature approval is not required. DO NOT submit expense information via KPERS/One Link.
3. CERTIFICATE OR PROOF OF COMPLETION FOR CME/CEU COURSE(S).
   The required certificate must contain the number of CME/CEU credits/hours awarded. A clean legible photocopy is acceptable.
   All forms must be submitted to:
   UNAC-UHCP/Management Education Oversight Committee
   Labor Relations Dept, 6th floor
   393 E. Walnut, Pasadena, CA 91188

The UNAC-UHCP/Management Education Oversight Committee will meet regularly to review and approve submitted requests. You will receive notice that your request has been approved via interoffice mail. If any information is missing or incomplete on any of the required forms, you will be notified that further action is needed, and additional information will need to be resubmitted prior to approval.

Once your CME/CEU reimbursement request is approved, please allow a minimum of 6 – 8 weeks for processing. You will not receive a separate check, but rather, will receive the approved amount as part of your biweekly paycheck, under earning code 847 – PA/NP CME/CEU CERT. The reimbursement will not be taxable income. You can see your paycheck on-line at: www.kppay.org

If you have any questions or concerns about this new process, please feel free to contact us at (626) 405-5838 or Tie-line 8-335-5838. Thank you for your cooperation and your commitment in continuing your educational development.

Sincerely,

UNAC-UHCP Joint Labor/Management Education Oversight Committee

Click to view samples of the CME REIMBURSEMENT REQUEST Form 2017 (Sample), and 2017 CME Reimbursement Expense Report (Sample)

Click to download live forms for CME-CEU REIMBURSEMENT REQUEST Form 2017, and 2017 CME Reimbursement Expense Report.