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Practitioner Information

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Enrollment Forms
Professional Confidentiality Statement
Enrollment Checklist - Initial and Annual Requirements
Enrollment Checklist - Second Annual and Ongoing Requirements for All Enrollees
Professional Development Hours Form (EI and SC)
Enrollment Application
Criminal Background Check
CFO Payee Agreement
Service Coordination Parent Exception Certification Statement
Practitioner Assurance Form
Practitioner Supervision Documentation
Rider A
Rider B
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 WVBTT 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
278 Companion Guide 278 Authorization Response Companion Guide
835 Remittance Advice 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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