SR 02-23 Dated 06/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the full automation of the provider enrollment and registration process on New HEIGHTS when new providers are added. The automated process is available to both District Office and NHEP staff and simplifies the process of enrolling a new provider. Since full automation applies only to the enrollment of new providers, paper forms are still required when making changes to provider information. BRIDGES will then update New HEIGHTS.

New HEIGHTS will now automatically generate 3-section Form WP0013, Provider Enrollment Packet, when a new provider is added to New HEIGHTS. The WP0013 consists of the following 3 sections:

·   Request for W-9 Information;

·   Alternate W-9 Form-CIS; and

·   Provider Enrollment and Registration Form.

In addition, the following DFA paper forms and associated instructions have been revised due to full automation:

·   Form AW-9L, Request for W-9 Information;

·   Form AW-9, Alternate W-9 Form-CIS; and

·   Form 251, Provider Enrollment and Registration Form.

BACKGROUND

Prior to the effective date of this SR, the provider enrollment process was not fully automated on New HEIGHTS. Form 251, Provider Enrollment and Registration Form, was available in a paper version only. Although New HEIGHTS generated Form AW-9L, Request for W-9 Information, (now known as section 1 of Form WP0013) and Form AW-9, Alternate W-9 Form-CIS, (now known as section 2 of Form WP0013) when a provider was added to New HEIGHTS, Form 251, now known as section 3 of Form WP0013, was not automatically generated. This meant that District Offices and NHEP teams were required to use paper Form 251 in addition to the automated process when enrolling a new provider and suppress New HEIGHTS-generated versions of sections 1 and 2 when authorizing services to a recipient. Full automation of the provider enrollment process for new providers eliminates the confusion associated with a partially automated process and makes it easier for providers to understand the enrollment process and to complete required forms.

FORMS REVISIONS

The forms used to enroll a new child care or NHEP provider with the Department to receive direct payment for goods and Employment and Training Support Services provided on behalf of a recipient, now exist in both a paper version and a New HEIGHTS-generated version as follows:

The footers in the forms instructions of both the paper and New HEIGHTS-generated versions of the forms contain cross references so that the paper versions and New HEIGHTS-generated versions can be easily identified. For example, the footer to the paper Form 251(i), Instructions for Form 251, contains the notation, "New HEIGHTS-generated Form WP0013, Section 3." The footer for section 3, Provider Enrollment and Registration Form, of Form WP0013(i), Instructions for Form WP0013, contains the notation "Paper Form 251."

Form 251, Provider Enrollment and Registration Form

Both the Child Development Bureau (CDB) and the Division of Family Assistance (DFA) use Form 251, Provider Enrollment and Registration Form, to gather information necessary to:

·   enroll a NH Employment Program (NHEP) provider on BRIDGES; and

·   register a child care provider on BRIDGES.

This form is either mailed or brought to a new provider with Form AW-9, Alternate W-9 Form-CIS. The provider must complete and return both forms to complete the enrollment and registration process. Both forms are required when a provider is requesting direct payment for goods or services from DHHS.

Form 251, Provider Enrollment and Registration Form, previously a 3-part NCR form, now a single page document, has been streamlined and reformatted. The carbon copies have been eliminated because copies are no longer necessary with the New HEIGHTS-generated version. Additional changes to Form 251 are noted below:

·   The Effective Date of the Transaction has been moved from the bottom to the top of the form.

·   An entry for the Resource Identification Number has been added to the top of the form to allow this information to be entered on all transaction changes and closings.

·   Two changes have been made to Section 1:

- a line for "Doing Business As" (DBA) has been added; and

- the term "Federal Identification Number" has been changed to "Employer Identification Number" to reflect current IRS terminology.

·   Section 3, previously used for child care registrations, has been removed and is now used for services provided.

·   The "State Office Use Only" box on the bottom of the form has been changed to allow DO and NHEP workers to enter their office location and for CDB to enter a Provider Registration Number. All other information has been removed from this area.

·   Instructions on the back of the Form 251 have been revised as noted below:

- more detailed information is given to the providers on completion of the form;

- providers are advised that upon enrollment they will receive a resource ID# and Key Name and that child care providers will be assigned a Provider Registration Number;

- notification is included to the provider/individual being enrolled that DHHS does not withhold tax money from money they receive from DHHS; and

- child care and NHEP providers are now instructed to send this form directly to BDM. Previously, NHEP received Form 251.

Form 251(i), Instructions for Form 251, has been revised accordingly.

Form AW-9, Alternate W-9 Form-CIS

Form AW-9, Alternate W-9 Form-CIS, is a 1-sheet document used to gather required Internal Revenue Service (IRS) information from providers who receive direct payments for child care or for items covered under Employment and Training Support Services. This form enables the Department to comply with IRS reporting requirements. Revisions are noted below:

·   a line was added to allow providers to enter their "Doing Business As" (DBA) name, and

·   instructions advise providers to complete the DBA line with a business name if they report income with a social security number.

Form AW-9(i), Instructions for Form AW-9, has been revised accordingly.

Form AW-9L, Request for W-9 Information

Form AW-9L, Request for W-9 Information, is a 1-sheet document used to inform providers about the need to provide required Internal Revenue Services (IRS) information if they wish to receive direct payments for child care services or for goods and services approved by the New Hampshire Employment Program (NHEP). Revisions to the form reflect procedural changes for NHEP providers as noted below.

·   Informs providers to complete Form AW-9 and Form 251 and return them to BDM. NHEP providers previously returned these forms to the NHEP Team members.

·   The term "Division of Transitional Assistance" was replaced with "Division of Family Assistance."

·   Clarifying language has been added to indicate that Form AW-9 is not required for each service a provider offers, and that providers of child care and Employment and Training Services are required to submit a single Form AW-9.

·   Providers are now reminded that a new Form AW-9 is required when they have a name or address change.

Form AW-9L(i), Instructions for Form AW-9L, has been revised accordingly.

NEW HEIGHTS-GENERATED FORMS

New HEIGHTS-generated Form WP0013, Provider Enrollment Packet, is used in the same manner as Form AW-9L, Request for W-9 Information, Form AW-9; Alternate W-9 Form-CIS and Form 251, Provider Enrollment and Registration Form. Form WP0013 may be printed locally or sent out in batch. Any changes to existing provider information must still be done with paper forms. BRIDGES will then update New HEIGHTS.

IMPLEMENTATION

New HEIGHTS began generating Form WP0013, Provider Enrollment Packet, on June 1, 2002. Use of the automated process for enrolling new providers is optional and the impact on District Offices and NHEP offices is addressed below.

District Offices

District Offices generally provide clients with paper Form 251 and Form AW-9 to enroll a new provider and may continue to use this same procedure, rather than accessing the automated enrollment packet. However, if District Offices continue to use the paper versions of the forms, staff must additionally provide the client with the Form AW-9L, per current policy, as it is part of the entire provider enrollment packet. Use the unrevised paper versions of the three forms until existing supplies are exhausted and then reorder a new supply through Stock Control in accordance with normal ordering procedures.

Some offices have the provider enrollment forms available in the forms rack under the forms sign in the lobby while other offices hand out these forms at the front desk. The forms sign in the lobby (if the District Office has one) will be revised in the future to include Form AW-9L as part of the forms necessary to enroll a new provider.

Additionally, if using the paper forms and a "doing as business name" (DBA) for a provider is known and the provider reports business income to the IRS under his or her own SSN, District Offices must enter this name directly under the provider’s Social Security Number and put "DBA" next to the name.

NHEP Offices

Prior to automation of Form 251, NHEP offices had to suppress the New HEIGHTS-generated versions of Forms AW9 and AW9-L when authorizing services to a recipient to prevent the provider from receiving duplicate forms. This is no longer necessary due to automation.

CLIENT NOTIFICATION

Clients will be notified on an individual as needed basis.

TRAINING

No training is determined to be necessary.

POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.state.nh.us/PMIndex.htm, effective August 1, 2002.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Forms Manual.

DFA/SJC:s