created for most services. When selecting services on the Consumer Service Detail tab, column I will prepopulate with the correct procedure code to be used for the federal billing. Non-FPS Services Service Waiver Documentation Unit Procedure need with Code Invoice 1 Assistive Technology and Services Item W5690 Receipt 2 Environmental Assessment Item W5740 Receipt 3 Environmental Modification Item W5750 Receipt 4 Family and Peer Mentoring Supports Hour W5760 Receipt 5 Family Caregiver Training and Empowerment Item W5770 Receipt 6 Housing Support Services Hour W5630 Receipt 7 Live-In Caregiver Supports Month W5877 Receipt 8 Nursing-Nurse Case Management and Delegation 15 minutes W5804 9 Nursing-Nurse Health Case Management 15 minutes W5802 10 Participant Education, Training and Advocacy Item W5780 Receipt 11 Remote Support Services Item W5820 Receipt 12 Respite Care-Camp Item W5850 Receipt 13 Respite Care-Daily Day W5822 Receipt 14 Respite Care-Hour Hour W5830 Receipt 15 Transition Services Item W5860 Receipt 16 Transportation (not Add-On) Item W5862 17 Vehicle Modification Item W5871 Receipt 18 Community Living Group Home Trial Day W0215 Receipt Experience (formerly Community Exploration) For the services that do not require receipts with the invoice, providers should maintain documentation of service provision. The DDA may conduct random audits of non-FPS services invoices by requesting all detailed documentation such as timesheets, logs, case notes, payroll and other evidence to substantiate invoice data. Participants may be authorized to receive services that are not included in the current Community Pathways Waiver program. This invoice template may be used to bill for these services as well but they would not be eligible for federal matching funds. So, 1500 forms would not be required for these services. The State-Only funded services are included in the list below. State-Only Funded Services 1 Other (State-Only Funded) 2 Rent-Individual Support (State-Only Funded) 3 Skilled Nursing (State-Only Funded) 4 Camp-Non-Respite (State-Only Funded) 5 Respite (State-Only Funded) 6 Transportation (State-Only Funded)
created for most services. When selecting services on the Consumer Service Detail tab, column I will prepopulate with the correct procedure code to be used for the federal billing. Non-FPS Services Service Unit Waiver Procedure Code Documentation need with Invoice 1 Assistive Technology and Services Item W5690 Receipt 2 Environmental Assessment Item W5740 Receipt 3 Environmental Modification Item W5750 Receipt 4 Family and Peer Mentoring Supports Hour W5760 Receipt 5 Family Caregiver Training and Empowerment Item W5770 Receipt 6 Housing Support Services Hour W5630 Receipt 7 Live-In Caregiver Supports Month W5877 Receipt 8 Nursing-Nurse Case Management and Delegation 15 minutes W5804 9 Nursing-Nurse Health Case Management 15 minutes W5802 10 Participant Education, Training and Advocacy Item W5780 Receipt 11 Remote Support Services Item W5820 Receipt 12 Respite Care-Camp Item W5850 Receipt 13 Respite Care-Daily Day W5822 Receipt 14 Respite Care-Hour Hour W5830 Receipt 15 Transition Services Item W5860 Receipt 16 Transportation (not Add-On) Item W5862 17 Vehicle Modification Item W5871 Receipt 18 Community Living Group Home Trial Experience (formerly Community Exploration) Day W0215 Receipt For the services that do not require receipts with the invoice, providers should maintain documentation of service provision. The DDA may conduct random audits of non-FPS services invoices by requesting all detailed documentation such as timesheets, logs, case notes, payroll and other evidence to substantiate invoice data. Participants may be authorized to receive services that are not included in the current Community Pathways Waiver program. This invoice template may be used to bill for these services as well but they would not be eligible for federal matching funds. So, 1500 forms would not be required for these services. The State-Only funded services are included in the list below. State-Only Funded Services 1 Other (State-Only Funded) 2 Rent-Individual Support (State-Only Funded) 3 Skilled Nursing (State-Only Funded) 4 Camp-Non-Respite (State-Only Funded) 5 Respite (State-Only Funded) 6 Transportation (State-Only Funded)
FY19%20CPW%20Non-FPS%20invoicing%20instructions_091118.docx