Provider Contract Resources

The following forms are provided as a resource for contracted service providers:

  • Billing Invoice (XLS, 38KB). This is the preferred Child Development Services billing invoice. It serves as an example to demonstrate the information required on invoices submitted to CDS for payment. CDS does accept HIPPA forms if they are augmented to include all information seen in this template. All contracted service providers must submit a monthly invoice for each child served.?Invoices must be mailed at least monthly.
  • Provider Transportation for MaineCare/Insurance Children (DOC, 94KB). Please complete this form each time you travel to provide services for MaineCare/insurance children. Forms should be mailed monthly.
  • IRS W-9 and ACH/EFT Authorization. All new contracted providers must provide CDS with a completed form W-9 before first payment will be processed.?We encourage all contracted providers to take advantage of electronic funds transfer (ACH/EFT) payment option. In order to begin receiving ACH/EFT payments, CDS must receive a completed authorization form.?Forms should be mailed to the CDS State Office.
  • Denial Reasons & Codes. All provider invoices are reviewed and approved for payment based on comparison to the specific child service plan.?Denial codes are printed on check stubs or EFT remittance advice, please refer to this link for explanation of specific codes.
  • Child Development Services Billing and Resource Manual (DOC, 70KB).?This manual explains all billing requirements, including Evaluation and Service Information Exchanges.

  • Make-Up Sessions (DOC, 42KB). CDS Administrative Letter Number 11 defines and explains requirements of make-up sessions.

  • Progress Monitoring Form (RTF, 1.5MB). Use this form to meet the written progress report requirement.?Progress reports shall describe the child's progress toward the goals in the child's IEP.?For children with disabilities ages three to five, quarterly progress reports will be based on the CDS Academic Calendar.