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Practitioner Information

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Enrollment Forms
ACCEPTABLE SIGNATURES ON BTT DOCS 6-8-21
CFO Payee Agreement -- FILLABLE
Contact Hours Documentation Form -- FILLABLE
Enrollment-Application Form -- FILLABLE
ParentSCstatement -- FILLABLE
Practitioner Assurance -- FILLABLE
Practitioner Supervisor Documentation -- FILLABLE
Rider A -- FILLABLE
Rider B -- FILLABLE
Enrolled Professional Confidentiality Statement ISC SC and Direct Service Practitoners -- FILLABLE
Enrollment Checklist Initial and Annual Requirements -- FILLABLE
Enrollment Checklist Second Annual and Ongoing Requirements for All Enrollees -- FILLABLE
Criminal Background Check
Entry Level Qualifications -- Revised on 11/17/2021
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
CKC Crosswalk Chart

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 to Override Denied Claim -- FILLABLE
Application for Claim Correction -- FILLABLE

Online Access Forms
RecommendedBrowsers Recommended Browsers
278 Companion Guide ISC Online Access Application
OSC Online Access Application
Practitioner Online Access Application

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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