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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.

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Enrollment Forms
Entry Level Qualifications -- Revised on 04/01/2020
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
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)
WVBTT Application for Override of Denied Claim WVBTT Application for Override of Denied Claim

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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