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What is a Provider Information Sheet?

April 26, 2017Provider Sheet

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What is a Provider Information Sheet?

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A. When an LEA is approved for participation in the School-Based Health Services program a computer-generated Provider Information Sheet is produced. It will also be generated when there is a change or update to the provider record. The Provider Information Sheet lists the provider name, address, provider number, etc., EXACTLY as the information should appear on submitted claims. The LEA should review the Provider Information Sheet for accuracy when it is received. If the information is correct, the Provider Information Sheet should be filed for reference when submitting future claims. Complete information regarding each entry on the Provider Information Sheet is available in Chapter U-200, Appendix U-3.