
At: Indiana First Steps Provider Enrollment c/o CSC P.O. Box 29160 Shawnee Mission, KS 66201-9160 Email: infsenroll dxc.com Fax: 913-888-6683 Phone: 1-866-339-9595 option 2 Annual credential checklist Annual credential form with signed attestation statement (page 3) Signed agreement with the Division of Disability and Rehabilitative Services (12 months current) Current limited criminal history from Indiana State Police (12 months current) National Provider Identifier (NPI) (required for a.
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How to fill out the IN First Steps Annual Credential Form online
Filling out the IN First Steps Annual Credential Form accurately is essential for maintaining your credential. This guide will provide you with step-by-step instructions to help you effectively complete the form online and ensure that all necessary information is submitted correctly.
Follow the steps to complete the form online.
- Press the ‘Get Form’ button to access the credential form, which you can open in an editor for online completion.
- Begin by completing your personal information within the 'Personnel Information' section. Include your name, email address, any previous names, phone number, and details about your professional license, including license type and expiration date.
- In the 'Prior Convictions' section, answer the question regarding criminal convictions honestly. Note that answering 'yes' does not automatically disqualify you from working in First Steps.
- If applicable, fill out the 'Supervision Agreement' section, ensuring the supervising provider's information, including their name, signature, and license details are provided, along with attachments of their credentials.
- Complete the 'My Trainings' section by listing relevant professional development training. Ensure you provide dates, titles, hours completed, and the competency areas for each training. You can duplicate this page to accommodate multiple entries.
- Finally, review the 'Attestation Statement' at the end of the form. Print your name, sign, and date to affirm that all provided information is accurate and true.
- Once all sections are filled out correctly, save your changes, then download or print your completed form. You can share it via email, fax, or mail as directed to the First Steps Central Reimbursement Office.
Complete your IN First Steps Annual Credential Form online today to maintain your standing and ensure compliance.
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To become a provider of Medicaid transportation, interested applicants must: Apply through the Indiana Health Coverage Programs (IHCP) by filling out an enrollment packet. Pay the application fee. This fee will vary depending on the risk level assigned by the Centers for Medicare & Medicaid Services.
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First Steps is funded by state and federal funds. Every family in Indiana, regardless of income or location, can access the First Steps program. First Steps services can begin at birth if needed, or at any time before your child's third birthday.
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Overview: The First Steps Progress Report is intended to serve as a comprehensive team report to document a child's progress toward the outcomes developed by the IFSP team, including the child's family. It is to be completed by ALL ongoing providers on a child's IFSP team who provided services during the report period.
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To become a CCDF certified unlicensed provider: To verify compliance, providers wishing to serve CCDF children, must submit all the required documentation and pass a CCDF provider eligibility inspection. Child care providers must meet the CCDF provider eligibility standards.
Is First Steps Indiana free?
Any child, age birth to three, in the state of Indiana is entitled to a free developmental evaluation.
How to become a first step provider in Indiana?
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Who is eligible for first steps in Indiana?
Who is eligible for First Steps services? Families who are eligible to participate in Indiana's First Steps System include those with children ages birth to three years old who: Are experiencing developmental delays. Have a diagnosed condition that has a high probability of resulting in a developmental delay.
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