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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

Recommended Browsers WV Birth to Three Entry Level Qualifications WVBTT Enrollment Checklist Initial and First Annual Update Revised 1-22-25 - Enrolled BEFORE 2-15-25 WVBTT Enrollment Checklist Initial and Annual Update Revised 1-22-25 - Enrolled AFTER 2-15-25 WVBTT Enrollment Checklist Second Annual and Ongoing Enrollment Revised 1-22-25 - Enrolled BEFORE 2-15-25 WVBTT Enrollment Checklist Second Annual and Ongoing Enrollment Revised 1-22-25 Enrolled AFTER 2-15-25 WVBTT CFO Enrollment Application NPI Taxonomy Codes CFO Payee Agreement Rider A - Local Service Practitioner Agreement Practitioner Supervisor Documentation Rider B - Service Coordinator Agreement Service Coordinator Parent Exception Certification Statement WV Birth to Three Enrolled Professional Confidentiality Agreement WV Birth to Three Documentation of Annual Professional Development Hours Criminal Background Check Practitioner Assurance Form Practitioner Online Access Application ISC Online Access Application OSC Online Access Application W-9 Birth To Three Direct Deposit Setup Birth To Three Direct Deposit Change Birth To Three Direct Deposit Cancel Birth To Three Core Knowledge and Competencies

Billing Information

WVBTT Billing Manual Services and Rates (PDF) Services and Rates (CSV) Application to Override Denied Claim -- FILLABLE Application for Claim Correction -- FILLABLE

Electronic Billing Information

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

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