Provider Enrollment

The First Steps policy manual became effective on September 1, 2018. To download a copy of the manual, click here.

To become a First Steps provider or service coordinator, individuals must:

  • Obtain a limited criminal history check through the Indiana State Police;
  • Sign a provider or service coordinator agreement with the Division of Disability and Rehabilitative Services;
  • Meet the entry level educational and licensure qualifications described in the section on entry level qualifications in the First Steps policy manual;
  • Obtain a National Provider Identifier (NPI) (service coordinators excluded); and
  • Submit an enrollment application and any required supporting documentation as indicated.

Please see the First Steps policy manual for policies on provider enrollment and credentialing. Training information and credentialing forms can be found here.

For a map of First Steps service areas and local agency contact information, click here.

Enrollment documents
Enrollment application and personnel information form
Provider agreement | required for all service providers and assessment team members
Service coordinator agreement | required for all intake and service coordinators
Agency and independent provider agreement | required for all agencies and independent providers
Monthly supervision report | as applicable

Additional forms for independent providers
Electronic Funds Transfer (EFT)
Online Access Form
W-9
Annual update form for exempt provider (required for providers who are exempt from First Steps credentialing requirements)

Other Resources
Provider training information and credentialing forms
Policy manual frequently asked questions (FAQ)
EI procedure codes/CPT cross reference 2017
EI procedure codes/CPT cross reference 2017 (CSV file)
Apply for a National Provider Identifier (NPI)
Indiana State Police Limited Criminal History Search
IHCP enrollment (Indiana Medicaid)
More information on IDEA Part C