FIELD ENTRY INFORMATION TYPE Summary of how the Individual feels that they performed during the service. Summary should be in INVIDUAL'S COMMENTS TEXT the own words; however, Provider Staff Individual’s (SELF ASSESSMENT) may have to ask clarifying questions. One word or simple phrases, e.g. got are not acceptable. “I this.” Discussion of progress with current benchmarks and PROVIDERS recommendations for further services. Providers should RECOMMENDATION & TEXT be specific on what still needs to be accomplished, how it will be measured, and an estimated amount of time SUMMARY needed to accomplish the goal. WORK INCENTIVES PLAN INVOICE SECTION INVOICE TOTAL $0.00 SERVICE DESCRIPTION FIELD ENTRY TYPE INFORMATION Use this field for Incentives or “Work Plan” “Work Incentives - If the Bilingual Supplement has Credential”. SERVICE DESCRIPTION been approved and authorized for the case select the DROP DOWN (UOS SERVICES) Work Incentives or Work “Bilingual Plan” “Bilingual Incentives option. This field will load the – Credential” associated rates, individual and/or group, as applicable. BENEFITS SUMMARY BENEFIT PROGRAM BENEFIT AMOUNT VERIFIED BY WHOM & HOW SOCIAL SECURITY $540.00 BPQY from Social Security Administration DISABILITY INSURANCE (SSDI) SUPPLEMENTAL SECURITY $200.00 BPQY from Social Security Administration INCOME (SSI) MEDICAL BENEFIT 1 (MEDICARE) Traditional Medicaid Telephone contact with Defiance County MEDICAL BENEFIT 2 (MEDICAID) (e.g. not MBIPWD) Jobs & Family Service. HOUSING BENEFIT BENEFIT 1 BENEFIT 2 BENEFIT 3 BENEFIT 4 BENEFIT 5
FIELD ENTRY TYPE INFORMATION INVIDUAL'S COMMENTS (SELF ASSESSMENT) TEXT Summary of how the Individual feels that they performed during the service. Summary should be in the Individual’s own words; however, Provider Staff may have to ask clarifying questions. One word or simple phrases, e.g. “I got this.” are not acceptable. PROVIDERS RECOMMENDATION & SUMMARY TEXT Discussion of progress with current benchmarks and recommendations for further services. Providers should be specific on what still needs to be accomplished, how it will be measured, and an estimated amount of time needed to accomplish the goal. WORK INCENTIVES PLAN INVOICE SECTION SERVICE DESCRIPTION INVOICE TOTAL $0.00 FIELD ENTRY TYPE INFORMATION SERVICE DESCRIPTION (UOS SERVICES) DROP DOWN Use this field for “Work Incentives Plan” or “Work Incentives - Credential”. If the Bilingual Supplement has been approved and authorized for the case select the “Bilingual Work Incentives Plan” or “Bilingual Work Incentives – Credential” option. This field will load the associated rates, individual and/or group, as applicable. BENEFITS SUMMARY BENEFIT PROGRAM BENEFIT AMOUNT VERIFIED BY WHOM & HOW SOCIAL SECURITY DISABILITY INSURANCE (SSDI) $540.00 BPQY from Social Security Administration SUPPLEMENTAL SECURITY INCOME (SSI) $200.00 BPQY from Social Security Administration MEDICAL BENEFIT 1 (MEDICARE) MEDICAL BENEFIT 2 (MEDICAID) Traditional Medicaid (e.g. not MBIPWD) Telephone contact with Defiance County Jobs & Family Service. HOUSING BENEFIT BENEFIT 1 BENEFIT 2 BENEFIT 3 BENEFIT 4 BENEFIT 5
VR%20Provider%20Manual%20-%20Effective%20010118.docx