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MEDICAID FORMS

[page updated October 2021]
Service providers: for your convenience, all pertinent forms for users of the SSoM Medicaid Service Portal are listed below with options to view/download. ALL forms with student information should be faxed to the SSoM office at (406) 624-6289 or sent using our secure webfile service:
ShareFile. Please DO NOT send student names via email.

CLICK TO VIEW  AND/OR DOWNLOAD THESE FORMS
Student Information Sheet​ ​
If a student is missing in the Service Portal this sheet should be filled out and sent to SSoM. This is a fillable PDF file : )
Child Profile Form with Instructions ​
​This form should be filled out for students requiring a Paraprofessional for Personal Care.
Service Portal Instructions
Gives logging guidelines for new and existing users (updated 2018)
Consent to Bill Medicaid 
​​This form should be filled out for a student on an IEP.  Be sure the parent checks the box to allow or deny the district from submitting eligible claims. Logs can be submitted to Montana Medicaid only after the date of the parent signature. ​
Annual Billing Notice
Required by Montana Medicaid to be sent or given to parents annually once the Consent to Bill Medicaid form ​has been signed.
Instructions for Nursing and Personal Care
Personal Care Services Daily Sheet

PROGRAM CONTACT

Lisa Waterman
Medicaid Billing Program Specialist

E-mail: lwaterman* (see below)
(406) 272-0073

School Services of Montana  |  4055 Valley Commons Drive, Suite G  |  Bozeman, MT 59718  |  (406) 247-0284
© 2023
*Please add @mt-schools.org to staff usernames when contacting us via email.
​
We made this change in an effort to discourage spam robots.
  • About Us
    • Members >
      • Become A Member
      • Member Benefits
      • Newsletter ARCHIVES 22-23 >
        • Newsletter ARCHIVES 21-22
        • Newsletter ARCHIVES 18-19
    • Overview of Services
    • Meet Our Staff
    • Employment Opportunities
  • Professional Learning
    • Upcoming Events >
      • Event Archives >
        • 2022 Curriculum Design Institutes
        • Science Summer Institute 2021
        • Common PIR Day 2019
        • Common PIR Day 2018
        • Science Summer Institute 2019 >
          • Session Details
          • Exhibitors & Sponsors
          • Exhibitor Registration
          • Half Page Handout
        • Science Summer Institute 2018
    • 2022 STEM Summer Institute >
      • SSI 2022 Schedule
      • Exhibitor & Sponsor Registration
    • Customized District PL
    • Virtual Courses
    • Curriculum Consortium >
      • Curriculum Resources
      • 2020-21 MECC Archives
      • 2019-20 MECC Archives
      • 2018-19 MECC Archives
    • Indian Education for All >
      • IEFA Archives >
        • IEFA MOR Institute 2019
      • IEFA Book Inventory
    • CPI Workshops
    • Meet Our Facilitators
    • General Cancellation Policy
  • Technology
    • Current Services
    • Meet Our Tech Team >
      • Tech Services Testimonials
      • SSoM Tech Events >
        • 2019 Tech Summit
        • 2018 Tech Summit
    • Infinite Campus Support >
      • Testimonials
      • Behind the Scenes at Infinite Campus
      • AIM/OPI User Guides
      • AIM Collection Schedule
      • Archives: Infinite Campus Emails
  • Medicaid Billing
    • Service Portal
    • Forms
    • Student Data Uploads
    • Medicaid Newsletter Archives
  • Co-op Purchasing
    • 22-23 SY Ordering Details
    • 2022-2023 Bid Details
    • Order Archives >
      • Spring 2022 Order Info
      • Fall 2021 Order Info
      • Spring 2021 Order Info
      • Fall 2020 Food Order
      • Spring 2020 Food Order
    • Bid Archives >
      • 2021-2022 Food Bid Info
      • 2020-2021 Bid A
      • 2020-2021 Bid B
      • Spring 2020 Bid
      • Fall 2019 Bid
      • Spring 2019 Bid
  • Blog
  • Donate