Get Targeted Case Management Forms

The Targeted Case Management Forms are essential documents for documenting services provided under Medicaid. This guide will take you through the process of filling out these forms online with clear and concise instructions.

Follow the steps to effectively complete the Targeted Case Management Forms.

1. Press the 'Get Form' button to access the Targeted Case Management Forms and open them in your preferred digital environment.
2. Begin by entering the date of the Individualized Education Program (IEP) at the top of the form. This is important for record-keeping.
3. Fill in the Medicaid number and WVEIS number in the designated fields to ensure accurate identification.
4. Input the county information, followed by the name of the teacher responsible for the case. Be sure to print the name clearly.
5. Enter the individual's last name and first name, along with their date of birth. This information is crucial for identifying the individual receiving services.
6. Document the month in which the services were provided, followed by the diagnosis code and school attended. This ensures all relevant details are captured.
7. Include the procedure code, listed as T1017, for accurate billing and documentation.
8. Choose the type of contact from the options provided: face-to-face, correspondence, or telephone contact, and note the date of service.
9. For each activity, record the type of contact, start time, end time, and total minutes for the activity. Be meticulous with these details.
10. Sign the form, providing your credentials to validate the documentation. Repeat the documentation for each additional TCM activity as necessary.
11. When you have completed all fields, save your changes, then download, print, or share the form as needed to submit it.

Start filling out your Targeted Case Management Forms online today to ensure efficient and accurate documentation.