Contracting Procedures
If you would like to become a CenterPoint Provider, you must complete a new provider application and send it, along with all required information (W-9, License and Proof of Liability Ins.), to the attention of John Coble at CenterPoint Human Services, 4045 University Parkway, Winston-Salem, NC 27106. If you have a question pertaining to contracting procedures, contact John Coble at 336-714-9117 or email: jcoble@cphs.org
Licensed Services - Services Directly Enrolled with DMA
Providers of licensed services for which direct enrollment with DMA is allowed or required may obtain a Memorandum of Agreement with CenterPoint upon request by providing the following:
- Copy of license
- Enrollment letter from DMA
- Proof of insurance in the required amounts
- W-9 Form with the legal name and federal Tax Identification Number
New Residential Providers must provide a Letter of Support (LOS)
Anyone pursuing a residential license for a facility in Davie, Forsyth and Stokes Counties is required to obtain a Letter of Support (LOS) from CenterPoint Human Services. The request must be in writing and contain the following content:
- Specify the exact license you are pursuing and provide the street address of the facility (no PO Box).
- Include the maximum number of rooms that your facility will house and convey the ages, gender and disability population that you plan to work with.
- Provide a “program description” that speaks to the services, treatment and supports that will be afforded your residents.
- Include any “clinical specialty,” that is the focus of the treatment and specialized population to be served, if applicable.
- Designate one contact person, include their position title and Agency name.
- Provide the phone and fax numbers as well as the e-mail address.
* Note: Quarterly Analyses are conducted with their findings determining the issuing of any LOS. Currently and through 6/30/09, NO LOS will be provided for .1300, .1700 nor .5600-C facilities.
New Provider Application
Insurance Requirements
Services Requiring Endorsement
General Contracting Guidelines