Go to Home Page. Search the Matrix for a Provider's Profile Update Your Matrix Entry/Login Help for Providers, Agencies, Parents and SPOES General Contact Information. Provider and Agency documents.
What forms do I need to enroll/credential?
     
  Step #1: You will need Adobe Acrobat Reader to view the documents.
     • Get Adobe here- it's FREE!
 
     
  Step #2: Download the First Steps Policy Manual:  
       • First Steps Policy Manual  
     
  Step #3: Enrollment Documents for ALL Providers:  
       • Agency Checklist source  
       • Agency and Independent Provider Agreement*    
       • Provider Agreement (Rider A)*    
       • Service Coordination Agreement (Rider B)*    
       • Enrollment Application    
     
  *Documents marked with an asterisk (*) must be submitted annually  
     
  Step #4: Additional Enrollment Documents for Independent Providers  
       • EFT Form  
       • Online Access Form  
       • W-9  
       • Annual Update For Exempt Providers*  
     
  *Documents marked with an asterisk (*) must be submitted annually  
     
  Step #5: Initial Credential Documents  
       • Initial Credential Application   
     
  Step #6: Annual Credential Documents  
       • Annual Credential Form  
     
  Other Helpful Documents:  
       • Handy CRO Numbers source  
       • Glossary of Terms source  
       • Policy Manual Frequently Asked Questions (FAQ)  
       • Credentialing Extension Request  
       • DT Release Form  
       • Independent PD Activity Approval Request  
       • Monthly Supervision Report  
       • EI Procedure Codes And CPT Cross Reference (2017)  
       • EI Procedure Codes And CPT Cross Reference (csv file)  
     
     




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