looking for the on the “Intake/Disclosure Validation Results” entry screen in ACD. “Checks” I. Instructions for Provider Disclosures and Screenings: Field Staff will: Use the HCS/AAA/DDA Individual Provider Contractor Intake form (revised April 2013) for all IPs seeking initial or renewal contracts for provision of in-home personal care services and/or DDA respite care services. Note: this form does not include I-9 related information. It is the responsibility of the client to have their IP/employee complete and retain the I-9. See DSHS form #11-055. of My Responsibilities as the Employer “Acknowledgement of My Individual Provider”. Ensure the provider returns the completed HCS/AAA/DDA Individual Provider Contractor Intake form. Providers who fail to submit this information cannot obtain a contract with ADS. Input the information gathered on the HCS/AAA/DDA Individual Provider Contractor Intake form into the ACD Contractor Screen as follows: For new Individual Providers: Create the new provider record in the ACD. The ACD will populate the screen with the “staff” provider’s Social Security Number. Input the Date of Birth (DOB) on the “staff” screen. Note: If a prior version of the intake form is used, locate the DOB on the or State ID, or the background Driver’s License check form. After 10/1/2013, enter the new record on the “Checks” screen, select and enter the date “Intake/Disclosure Form” the new record is created. For IP renewals: When the contract is renewed, update the provider record with any corrected information and the date the new IP Contractor Intake form was signed. Edit the screen to add the DOB and ensure the SSN “Staff” field is populated. After 10/1/2013, enter the new record on the “Checks” and enter the date. screen, select “Intake/Disclosure Form” Maintain the completed HCS/AAA/DDA Individual Provider Contractor Intake form in the Contract file. After 10/1/2013, verify the validation was completed and provider’s approved by ADS Headquarters Contract Staff (see ADS Headquarters Contract Staff actions outlined in section 2 below). All verification of validation can be found on the ACD provider’s Contractor screen. “Check” If the provider passes the screen completed by HQ contract
looking for the “Intake/Disclosure Validation Results” entry on the “Checks” screen in ACD. I. Instructions for Provider Disclosures and Screenings: Field Staff will: Use the HCS/AAA/DDA Individual Provider Contractor Intake form (revised April 2013) for all IPs seeking initial or renewal contracts for provision of in-home personal care services and/or DDA respite care services. Note: this form does not include I-9 related information. It is the responsibility of the client to have their IP/employee complete and retain the I-9. See DSHS form #11-055. “Acknowledgement of My Responsibilities as the Employer of My Individual Provider”. Ensure the provider returns the completed HCS/AAA/DDA Individual Provider Contractor Intake form. Providers who fail to submit this information cannot obtain a contract with ADS. Input the information gathered on the HCS/AAA/DDA Individual Provider Contractor Intake form into the ACD Contractor Screen as follows: For new Individual Providers: Create the new provider record in the ACD. The ACD will populate the “staff” screen with the provider’s Social Security Number. Input the Date of Birth (DOB) on the “staff” screen. Note: If a prior version of the intake form is used, locate the DOB on the Driver’s License or State ID, or the background check form. After 10/1/2013, enter the new record on the “Checks” screen, select “Intake/Disclosure Form” and enter the date the new record is created. For IP renewals: When the contract is renewed, update the provider record with any corrected information and the date the new IP Contractor Intake form was signed. Edit the “Staff” screen to add the DOB and ensure the SSN field is populated. After 10/1/2013, enter the new record on the “Checks” screen, select “Intake/Disclosure Form” and enter the date. Maintain the completed HCS/AAA/DDA Individual Provider Contractor Intake form in the Contract file. After 10/1/2013, verify the provider’s validation was completed and approved by ADS Headquarters Contract Staff (see ADS Headquarters Contract Staff actions outlined in section 2 below). All verification of provider’s validation can be found on the ACD Contractor “Check” screen. If the provider passes the screen completed by HQ contract
h13-056%20changes%20in%20individual%20provider%20contractor%20intake%20form%20and%20process.doc.docx