Procedure for Contracting with Saratoga County to provide CPSE Services

  1. Contact the Saratoga County Department of Health regarding interest to contract at 518-584-7460
  2. Complete and submit State Central Registry Clearance forms to the Saratoga County Department of Health
  3. Once cleared, the Saratoga County Department of Health will send and require documentation below:
    1. 3 original signed copies of the contract
    2. Provider agreement
    3.  Appendix A – Description of services and locations
    4. Appendix B – Statement of Medicaid Reassignment
    5. Providers Insurance must include:
      • Name of provider, NYS authorized insurance company, policy number
      • Professional liability insurance with coverage at a minimum of $1 million per incident and $2 million in the aggregate
      • Professional, workplace, abuse and molestation insurance coverage, general or Off-Premises liability policies shall be in an amount of coverage not less than $1,000,000 per incident/occurrence, and $2,000,000 in the aggregate.  An endorsement naming County of Saratoga, 40 McMaster St., Ballston Spa, NY 12020 must be provided to prove this additional insured on the General/Off Premise liability only.
      • Abuse and molestation coverage.  Endorsement not necessary from Savers, CNA/HPSO, and American Home insurance providers (included in policy)
      • Proof of payment on memorandum or a receipt
    6. Current resume
    7. A copy of your license/diploma, current registration, teaching certification and evidence of ASHA membership (if speech pathologist)
    8. Documentation of your National Provider Identifier number
    9. School Supportive Health Services Program (SSHSP)-Medicaid number-(if speech pathologist)

Executed contract is sent back to the Saratoga County Department of Health.  Provider is notified and sent a packet of information explaining billing, vouchers, claims, etc.

Loading