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?
     
  Step #1: You will need Adobe Acrobat Reader to view the documents.
Get Adobe here- it's FREE!		  
     
  Step #2: Everyone needs all of these forms:  
  Inquiry Form  
  Instruction Sheet  
  Handy CRO Numbers  
  W-9  
  CRO Agreement    
  Glossary of Terms  
  Personnel Guide  
  Matrix Guidelines  
  Matrix  
  Professional Competencies of Early Intervention  
  Service Definitions  
  Usual and Customary Rate Information  
     
  Step #3: Download one checklist to determine what files you need for Step #4.  
  I am an independent provider  
  I am an independent DT provider  
  I am an independent Service Coordinator  
  I am a provider working with a facility  
  I am a transportation provider  
  I am a provider with a facility  
  I am a DME or Interpreter  
     
  Step #4: Download the individual files you need determined from Step #3:  
  Medicaid Agreement  
  Medicaid Cover Letter  
  Rider A    
  Rider A with a Supervisor  
  Rider B    
  Rider B with a Supervisor  
  State Police Cover Letter  
     
  Please call 888-567-2351 ext. 2 for the State Police Form to be mailed to you.  
     
  Back to Documents Main Page  
     




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