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Practitioner Information

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In addition to any of the following forms and documents, please download and read the following FAQ document. This document contains the most commonly asked questions we receive. Click here for the Questions and Answers Document.

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

Electronic Billing Information
Billing Manual HIPAA 278 Authorization Response Companion Guide
837P Claims Transaction Companion Guide
Trading Partner Agreement
EDI Testing Procedures EDI Testing Procedures

How To Get a Free Email Account

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