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Contracting

Home/Providers/Contracting
ContractingInclusa2021-01-28T00:39:26+00:00

Application and Contracting Reference

  • Provider Training: Inclusa Provider Development, Contracting, and Credentialing Policies

Application Forms

  • Provider Application
  • W-9 Form
  • Background Information Disclosure (BID)
  • Owner Occupied Adult Family Home (AFH) Certification Application
  • AFH Certification Application Community Care Home
  • Residential Provider Service Form
  • Provider Application-Service Location Form

Contract Appendix C: Provider Insurance Coverage Minimums

  • Contract Appendix C – Provider Insurance Coverage Minimums

Contract Appendix N: Scope of Service

  • Adaptive Aids – Service Dogs
  • Adult Day Care
  • Community Support Program (CSP)
  • Community Supported Living (CSL)
  • Consultative Clinical and Therapeutic Services
    for Caregivers
  • Consumer Education and Training
    (includes Mental Health Peer Specialists)
  • Counseling & Therapeutic Resources (Non-MA)
  • Daily Living Skills Training
  • Day Habilitation Services (Adult Day Services)
  • Environmental Accessibility Adaptations
    (Home Modifications)
  • Financial Management Services – Representative Payee
  • Financial Management Services for Self-Directed Supports
  • Home Delivered Meals
  • Home Health
  • Housing Counseling
  • Independent Nursing
  • Mental Health-AODA
  • Personal Emergency Response System (PERS)
  • Physical and Occupational Therapy, Speech & Language Pathology
  • Prevocational Services
  • Residential Services – Adult Family Home (AFH)
  • Residential Services – Community Based Residential Facility (CBRF)
  • Residential Services – Residential Care Apartment Complex (RCAC)
  • Support Broker for Self-Directed Supports
  • Supported Employment
  • Supportive Home Care
  • Supportive Home Care – Chore Services
  • Supportive Home Care – Days
  • Training for Unpaid Caregivers
  • Transportation (Specialized Transportation)
  • Vocational Futures Planning & Support (VFPS)

Phone: 877-622-6700
TTY: 711
Offices: click here

After-Hour Authorizations
Monday-Friday: Before 8am & After 4:30pm
Weekends & Holidays: All Day
Toll-Free: (800) 285-6425

Mailing Address:
3349 Church Street
Stevens Point, WI 54481

Copyright 2019 Inclusa, Inc. | All Rights Reserved
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