How to Become a DIDD Provider

Applicant Forums

New Provider Application Review Policy

Application for Long Term Services & Support Coordination

  1. Initial Screening Questionnaire for Long Term Services & Support Coordination Services / Part 1
    1. W-9 Form - must be submitted with application
    2. Disclosure Form for Provider Person or Entity - must be submitted with application
    3. Instructions for Submitting National Background Check to DIDD, contact Linda Maurice at 615-532-6568 or Linda.maurice@tn.gov
  2. Application for Long Term Services / Part 2
    1. Available Service Rates
    2. TN Residential Provider Self-Assessment - must be submitted with the Part 2 application
    3. TN Non-Residential Provider Self-Assessment - must be submitted with the Part 2 application if applicable
  3. Application for Support Coordination / Part 2
    1. Available Service Rates

Application for Clinical & Ancillary Services

  1. Provider Application for Clinical and Ancillary Services
    1. W-9 Form - must be submitted with application
    2. Disclosure Form for Provider Person or Entity - must be submitted with application
    3. Information for Behavior Analyst and Behavior Specialist Services
  2. Audiology Services
    1. Application Process Checklist
    2. Required Policy List and Sample Policies
  3. Environmental Accessibility Modifications Services
    1. Application Process Checklist
    2. Applicant Information
  4. Nursing Services
    1. Application Process Checklist
    2. Required Policy List and Sample Policies
    3. Resource Handbook for the Professional Support Services License
  5. Nutrition and Orientation and Mobility Services
    1. Application Process Checklist
    2. Required Policy List and Sample Policies
  6. Occupational Therapy, Physical Therapy, and Speech Language Pathology Services
    1. Application Process Checklist
    2. Required Policy List and Sample Policies
    3. Resource Handbook for the Professional Support Services License can be found above in Section 4. Nursing Services
  7. Specialized Medical Equipment, Supplies, and Assistive Technology Services
    1. Application Process Checklist

Application for Dental Services and/or Anesthesia Service

  1. Credentialing Application for Dental Services and/or Anesthesia Service
    1. W-9 Form - must be submitted with application
    2. Disclosure Form for Provider Person or Entity - must be submitted with application

 

Completed applications must be typed, signed, scanned and sent in PDF form to DIDDProvider.Application@tn.gov