Here's how it works
01. Edit your certification verification online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send tp1 form via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out Medicaid TP Form with our platform
- Click ‘Get Form’ to open the Medicaid TP form in the editor.
- Begin by filling out the Client Information section. Enter the client's first name, last name, CSHCN Services Program number, date of birth, and address including city and ZIP code.
- In the Evaluation Summary section, input the date of evaluation and check the appropriate type of evaluation (PT, OT, or SLP). Remember to attach a copy of the initial evaluation.
- For the Service Request section, indicate procedure codes, modifiers (GP for PT, GO for OT), dates of service (not exceeding six months), and frequency per week or month.
- Complete the Provider Information section by entering provider details such as name, TPI, NPI, taxonomy code, contact information, and ensure that the provider signs and dates the form.
Start using our platform today to easily fill out your Medicaid TP form online for free!
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