Below we are providing a list of up-to-date forms for vendors with existing contracts in the wrap around system of care.
Schedule 1.2: Covered Services and Fee Schedule
Use this form to list service codes and services that your agency will provide to the system of care.
Schedule 3.1: Vendor Demographic Data Form
Use this form to assess individual skills, knowledge and professional experience for each working. It will allow you identify service codes these individuals will be working under in the Care Manager and Family First systems. If you do not have an existing contract, serving Erie County, and wish to become part of the Vendor Network please contact David Monroe.
Schedule 3.2: Agreement by Designated Personnel
Individual workers should sign this as proof of their knowledge of duties and responsibilities when providing service within the system of care. This an essential document for contract execution for existing vendors.
This is the up-to-date listing of what we currently offer to the Erie County’s system of care within the wrap around process. It will give you a description of the service, qualifications necessary to provide this service, and reimbursement fees categorized by vendor code.
Request to Add a New Provider Agency:
This form is used to designate a vendor as a Waiver provider and begin the process of registering your organization for OMH free finger printing sponsorship.
