Filing Instructions for nursing homes NOT enrolled in Medicaid
The files available below provide information about 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..."
Provider Fee Report Not in Medicaid (Not Exempt) - Updated 12/20/16
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 06/04/14
Send the completed Excel data file as an e-mail attachment to the department at firstname.lastname@example.org. Reports must be submitted by the 30th day following the end of the reported quarter.
If you have any questions about the provider fee program or reporting requirements, please consult the Directory of Contacts listing and contact the person designated for the subject of your questions.
Directory of Contacts in Medicaid - Updated 07/26/13