Documents/Forms

Reference materials for Providers and Administrative Staff are listed below offering information and guidance on the implementation and administration of the School Based Child Health (SBCH) Program:

• CT-SBCH Program Dates and Deadlines (FY27)
• Connecticut iC MMIS Provider Manual
• Fee For Service Interim Rates (updated January 2026)
• RMTS User Guide
• RMTS Power Point Summary
• CT-SBCH Participant Management Guide
• CT-SBCH Work Schedule Calendar Guide
• CT-SBCH Participant Quick Reference Guide (FY25)
• SBCH User Guide (Revised May 2022)
• Technical Notes and System Requirements

Administrative Activity Claim (ACC) Information SBCH Admin Claiming Training Video (MP4)

SBCH Administrative Claiming reimburses for RMTS participants administrative efforts (as determined by Time Study result) applied to salaries and fringe benefits. Additional expenses available include capital costs (buildings, fixed assets, and major moveable equipment) and non-personnel costs (i.e. supplies) pertaining to Medicaid Administrative functions. Medicaid Administrative functions support Medicaid eligibility determination process, Medicaid outreach, or supports SBCH covered services as described in the State Plan Amendment. Administrative claiming is submitted on a quarterly basis.

• Administrative Activity Claiming Guide
• Administrative Activity Claiming Instruction Guide
• Administrative Activity Claiming Webinar Q&A
• Quick Step-by-Step Overview
• SBCH CC Upload Template

 

Cost Report Information

• Direct Cost Report Training Video
• Cost Report Instructional Manual
• Direct Medical Services and Transportation Cost Report Training

 

Medicaid Service Information (MSI)

• Claim Submission to DAS Guidelines
• Claim Resolution Guide to Understanding EOB Codes
• MSI Claim Form In-District (Effective 7/1/2026)
• MSI Claim Form Out-of-District (Effective 7/1/2026)
• MSI Claim Form Out-of-District with Comments (Effective 7/1/2026)
• MSI Form Part 2 (Revised May 2022)