Filing Instructions for nursing homes enrolled in Medicaid
The files available below provide information about current reporting requirements and instructions for how provider fees should be paid.
NOTE: Clicking on the documents may open them in a new browser window. To download the files to your hard drive, right-click the file (Control-click on Macintosh) and choose "Save Target As..."
Quarterly report for single site -- Updated 03/28/17
Quarterly report for single site (If partial period only) - Updated 03/28/17
Quarterly report for multi-sites -- Updated 03/28/17
Send the completed Excel data file as an e-mail attachment to the department at firstname.lastname@example.org.
Provider Fee Payments
This file includes the forms needed to set up the electronic funds transfer for payment of provider fee payments. The forms may also be used to make changes to facility name, home office name, contact person, and bank information related to provider fee payments (only).
Instructions for how provider fees should be paid - Updated 10/30/14
Link to the Velocity Payment Gateway: https://www.velocitypayment.com/vbills/bankofamerica/gdch/login.go
If you have any questions about the provider fee program or reporting requirements, please consult the below directory and contact the person designated for the subject of your questions.
Directory of Contacts in Medicaid - Updated 7/26/13