We know there are lot of forms schools use for school-based Medicaid billing. We’ve tried to take those forms and organize them below based on whether they are for a student, provider, or need to be done at the start of the school year. However, if you still don’t see something or have a question please call or email us, we are happy to help!
- Case Management
- Development & Assistive Therapy Log
- District Information Form
- Evaluation Claim Form & Sample
- Form 5b
- Form 5c
- Form 7a
- IEP Claim Form & Sample
- Out of District Provider Certification Agreement
- Personal Care Log
- Personal Care Verification Form
- Physician Authorization Form
- PNMI Claim Form
- Provider Certification Agreement
- Related Services Log
- Release of Information
- Release of Information Form – 18 Year Old Student
- Student Additions/Deletions
- Unscheduled Closure Form