PROVIDER AGREEMENT

Providers will be required to download and complete the entire Provider Agreement and Attachments AA – FF for the Rural Nevada Contracts with DCFS.  It will be a requirement for all Specialized Foster Care Home’s to complete and return the Provider Agreement to DCFS for approval, prior to placement of children.  Please check with Clark County and Washoe County for completing Contracts for these Nevada jurisdictions.

Return entire completed packet to:

Division of Child and Family Services
Fiscal Unit
4126 Technology Way, 3^rd Floor
Carson City, NV 89706

• Provider Agreement (3-1-12) - Specialized Foster Care (pdf)

• Scope of Work-Specialized Foster Care (7-1-09) – Attachment AA (pdf)

• Insurance Schedule Requirements (7-1-09) – Attachment BB (pdf)

• Confidentiality Addendum – Attachment CC (pdf)

• Provider Enrollment Packet-Specialized Foster Care (7-1-09) – Attachment DD (word)

• Rate Schedule-Specialized Foster Care (7-1-09) – Attachment EE (pdf)

• Fiscal Procedures - Specialized Foster Care (7-1-09) – Attachment FF (pdf)

• Provider Agreement Checklist (pdf)

• Rate Schedule-Foster Care (06/18/2008) (pdf)

Billing Format Templates

Below please find the preferred monthly billing templates that must be submitted each month with the appropriate supporting documentation to (see above Fiscal Procedures-Specialized Foster Care):

Division of Child and Family Services
Fiscal Unit
4126 Technology Way, 3^rd Floor
Carson City, NV 89706

• Provider Billing Statewide Non-DCFS Custody (2-1-11) (Excel)

• Provider Census Rural DCFS Custody (7-1-09) (Excel)

• Provider Appeal Process Billing Form (Excel)

To read these documents, you will need Adobe Reader