Medicaid Qualified Provider Documentation – DnA & ISE

This article will walk through how to access and complete the Medicaid Qualified Provider Documentation that is required anytime a new IEP, IFSP, Permission to Place or an amendment (where a new service has been added that was not in the IEP) to meet Medicaid Policy requirements.

Where to Start

Via the Special Services Module:

1. Select Special Services.

2. Select Medicaid Qualified Provider.

Via Search/Quick Search:

1. Open up Search/Quick Search.

2. Begin typing Medicaid Qualified Provider.

3. Select Medicaid Qualified Provider from the dropdown results.

Medicaid Qualified Provider Landing Page

1. Functions are:

Pencil Icon: Edit

Eye Icon: View

Red circle/Minus Sign Icon: Delete

Printer Icon: Print PDF.

2. Name of the Qualified Provider that signed the document.

3. Date/time stamp of electronic signature of the Medicaid Qualified Provider.

4. Green Circle/Plus Sign: Create a new Medicaid Qualified Provider Form.

Create a New Medicaid Qualified Provider Form

Select Green Circle/Plus Sign Icon.

Add Data

1. Select YES if the student has a current IFSP. Select NO for IEPs, IEP amendments and Permission to Places.

2. Enter your name.

3. Add your credential(s).

4. Sign your name.

5. Select OK if you are satisfied with your signature or Reset to redo your signature.

NOTE: Once OK is selected a Pop Up Screen will appear for you to confirm it is your signature and notifying you that your signature will be locked once you select OK.

OPTIONAL: Add Additional Qualified Providers

6. To add additional Qualified Providers select the Role name from the dropdown. NOTE: You do NOT add yourself to this section as you are the providing signing and are already therefore on the document.

7. Begin typing the Qualified Provider's name and select it from the dropdown.

8. Click within the text box and select all of the Qualified Provider's credentials.

9. Select Add Qualified Provider to add.

NOTE: Continue steps 6-9 until all Qualified Providers have been added.

10. Select SAVE to save the page.

11. Select Back to Medicaid Qualified Provider Forms to go back to main page.