Get Ia Total Care Medicaid Hcbs Waiver Provider Application 2019-2025

Filling out the IA Total Care Medicaid HCBS Waiver Provider Application online can ensure a smooth enrollment process. This guide will walk you through the necessary steps and provide helpful information to ensure that your application is completed accurately.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the Basic Information section. Ensure all required forms are completed, and types or print your responses legibly. Use 'N/A' for non-applicable fields.
3. In the General Section, check the reason for application and provide your National Provider Identifier if applicable. Fill in the legal name corresponding to your W9 form.
4. Enter your email address. This allows Iowa Total Care to communicate with you electronically. Then input your desired effective date for enrollment.
5. If applying for Consumer-Directed Attendant Care (CDAC), complete section II by providing your Social Security Number and selecting applicable HCBS waiver programs.
6. Individuals should submit proof of age, attaching a photocopy of the birth certificate or driver’s license. For agencies and businesses, provide the Tax Identification Number and submit the signed W-9 form.
7. In section III, agencies must indicate which services they are applying for and check relevant boxes for qualifying standards.
8. Signature and date fields must be completed accurately. Ensure all applications are duly signed to avoid delays.
9. Review all sections for completeness, attaching any required supporting documents. An incomplete application may delay processing.
10. Once finalized, save the changes, download, print, or share the completed form as necessary.

Take the next step in your application process and fill out the form online today.