Documents & Resources
You are now able to add and/or remove SUD Provider Staff via the link below. Please remember that adding staff requires documentation to include a valid IDHW CHU Enhanced Background Check confirmation. More information is found on the form. Please contact us if you have any questions 1-800-688-4013.
This form is used to add or remove an address, update office operations, update specialty attestation, and submit important documents.
https://www.cognitoforms.com/BPAHealth/SUDAddRemoveAddressForm
This is a sample template for a standard release of information.
This document will allow you to preview the SUD application to assist you in preparing to complete the form. To view the form, please click the download button. To fill out the SUD Provider Initial Application, please click here.
Child Welfare Case Termination Form used to notify BPA Health a clients Child Protection case has been closed and will no longer be eligible to receive services funded through Child Protection Substance Use Disorder (CP/SUD).
This form is for use by SUD Network providers when submitting an appeal.
Please click the link with the down arrow above to access a copy of the form that needs to be filled out.
Encuesta de Seguimiento de Consentimiento Informado
Spanish Informed Consent for Follow-up Survey Form
IDHW Memo sent to IROC MAT Prescribers. Includes a form that outlines the process for prescribers when working with funded clients
Autorizacion para el uso o revelacion de informacion a la agencia/entidad aprobada.
Spanish Release of Information form.
If you would like to be removed from the EAP or SUD Networks, please complete this brief form.
https://www.cognitoforms.com/BPAHealth/bpahealthprovidernetworkoptoutrequest
To view the communication from IDOC regarding this form, either please the link below or click the download button to the above right.
IDOC Status Report Communication
To access the IDOC Monthly Status Report Form directly, please click the link below:
IDOC Monthy Status Report Form
20161104_Updated-IDHW-General-Release-Form
Release of information form for Idaho substance abuse treatment and recovery support services.
If you are an SUD Agency or EAP-BH Provider with BPA Health, we will electronically transfer funds directly into your account if you would like. Signing up for automatic deposits, also ensures a quicker turn-around time for you to receive your funds.
To sign up, please click below or click on the arrow above.
Implemented February 25, 2019.
All treatment providers and sites in the BPA Health network must be co-occurring capable. Be prepared to demonstrate these capabilities in a co-occurring assessment form. This form is required to be submitted at time of facility renewal as well as any time a provider believes they may have moved from Capable to Enhanced.
To access the form, click on the arrow above.
Request for taxpayer identification number (TIN) for reporting on an information return (e.g., 1099-MISC) the amount paid.
Click here for W-9 fillable form
The purpose of this form is to update BPA Health and the state with written descriptions of the Evidence-Based Practices (EBP) you are offering at each of your locations. Make sure to complete for any new EBPs you would like to offer as well as list any EBPs you are no longer offering.
To access the form, click the arrow above.