Human Services-Service Provider Page

Resources for current or potential service providers contracted with, or hoping to contract with, Bayfield County Department of Human Services. These regulations are in place to protect consumers, providers, and the County.

Contract content varies depending on many things such as the amount, type of service and funding. Agreements may include an emergency response page, HIPPA business associate agreement, TPA billing agreement and other clauses specific to certain services.

ALL PROVIDERS

All providers must submit a completed W-9 form and Civil Rights Compliance Letter of Assurance (CRC LOA). These forms and instructions are listed below:

  • W-9-(fillable form and instructions)
  • CRC LOA-(fillable form)

OTHER PROVIDER REQUIREMENTS

Depending on the type of agreement and service you are providing, you may be required to submit:

  • Proof of liability insurance coverage-this is done by providing a certificate obtained from your insurance agency, or a copy of the policy page that states limits and coverage dates. Limit requirements are listed in the contract.
  • License copies-this may include State licensing for professionals, organizations, or locations such as camps.
  • A full CRC plan-instructions and sample plans may be found at the CRC Instuctions link above.
  • Annual Program or agency-wide audit
  • Forms specific to certain programs/grants

PROVIDER RESOURCES SPECIFIC TO PROGRAMS

Children's Long-Term Support Waiver Program (CLTS)-These providers must register with the State and bill the third party administrator, although the contract is arranged through Bayfield County Department of Human Services. Instructions on how to register/bill may be viewed at the State CLTS Provider page.