Billing Forms

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

Please mail these forms to the CDS State Office, Attention: Accounts Payable. 

  • Billing Invoice (XLS, 16KB). This template 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. Forms should be mailed 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.