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CSSNEWPORTALBILLING FORMRev062411 doc

CSSNEWPORTALBILLING FORMRev062411 doc 2025

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The document is a billing form for Consolidated Supports and Services (CSS) provided to non-waiver individuals. It includes sections for agency information, service details, individual names, and payment certification. The form requires compliance with federal civil rights laws and mandates record-keeping for six years. Claims submitted more than two years after the service date must include an explanation letter. Completed forms should be sent to the New York State Office for People with Developmental Disabilities.

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