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Enrollment Forms

Professional Development Hours Form (EI and SC) Enrollment Checklist - Initial and Annual Requirements Enrollment Checklist - Second Annual and Ongoing Requirements for All Enrollees Enrollment Application Criminal Background Check CFO Payee Agreement Service Coordination Parent Exception Certification Statement Practitioner Assurance Form Practitioner Supervision Documentation Rider A Rider B W-9 Entry Level Qualifications Birth to Three Direct Deposit Setup Birth to Three Direct Deposit Change Birth to Three Direct Deposit Cancel WV Birth To Three Core Competencies Revised 0508

Billing Information

WVBTT Billing Manual Services and Rates (PDF) Services and Rates (CSV) Application for Timely Filing Waiver

Electronic Billing Information

278 Authorization Response Companion Guide 835 Remittance Advice Companion Guide 837P Claims Transaction Companion Guide Trading Partner Agreement EDI Testing Procedures

How To Get a Free Email Account