Provider will complete the Provider Qualification Documentation Record, PQ Form Documents can be found on under Resources AE will review information, correspond with → DP 1059 and New Provider Self-Assessment and submits with supporting Intellectual Disability Resources→ provider and if approved, will forward signed documentation to the AE in which they intend to provide the most service. Waiver Services Process copy of PQ FORM DP 1059 back to provider. →|Qualification → Provider Qualification_2 Provider to goes to the electronic Provider Enrollment Application website and applies for the Specialties they are qualified for. They will need their supporting documentation including Approved APC letter (if needed), and DP FORM 1059 to ODP Enrollment for each site. Other forms may be required depending on the specialty of service ODP Provider Enrollment unit will review application and if approved, enroll the 888-565-9435 Automated letter generated by OMAP and sent provider in PROMISe thru confirming site enrollment details. USPS ODP Provider Enrollment will contact the HCSIS Help Desk and provide the FEIN The provider will receive notification from the number of the provider for ODP roles to be added. The provider may now add HCSIS helpdesk that you have an ODP role to services they are qualified for in HCSIS access HCSIS. Rates are loaded into PROMISe and contracts are created in HCSIS within 5-7 business days. Support Coordinator can now add services to an ISP.
Provider will complete the Provider Qualification Documentation Record, PQ Form DP 1059 and New Provider Self-Assessment and submits with supporting documentation to the AE in which they intend to provide the most service. Documents can be found on under Resources → Intellectual Disability Resources→ Waiver Services →|Qualification Process → Provider Qualification_2 AE will review information, correspond with provider and if approved, will forward signed copy of PQ FORM DP 1059 back to provider. Provider to goes to the electronic Provider Enrollment Application website and applies for the Specialties they are qualified for. They will need their supporting documentation including Approved APC letter (if needed), and DP FORM 1059 to ODP Enrollment for each site. Other forms may be required depending on the specialty of service ODP Provider Enrollment unit will review application and if approved, enroll the provider in PROMISe 888-565-9435 Automated letter generated by OMAP and sent thru USPS confirming site enrollment details. ODP Provider Enrollment will contact the HCSIS Help Desk and provide the FEIN number of the provider for ODP roles to be added. The provider may now add services they are qualified for in HCSIS The provider will receive notification from the HCSIS helpdesk that you have an ODP role to access HCSIS. Rates are loaded into PROMISe and contracts are created in HCSIS within 5-7 business days. Support Coordinator can now add services to an ISP.
New+Provider+Process+unLicensed+1052017.docx