1) Introduction to Re-Certification
2) RE-Certification Attestation Form
3) Data Collection Training Request Form
4) Downloadable Forms

Introduction to Re-Certification

This module is only relevant to those agencies who currently hold a Certificate as a Treat First Agency.  At the bottom of your certificate, there is a ‘Period of Certification.’ It indicates when the period of your agency’s particular Certification ends.

In this talk, I am going to go over the steps for those of you need to apply for RE-certification. You are encouraged to electronically submit your RE-Certification forms before the end of your certification period.  There are only two forms required for recertification: 

  1. RE-Certification Attestation Form  
  2. RE-Certification Data Collection Training Request Form

 

Steps to Re-Certification

  1. Use the earlier modules in this website to re-orient your organization to the Treat First Approach; and to train those new staff who will be implementing Treat First.  If your staff have not been trained in the TxF modules within the last six months, you will be asked in this form to attest to their having a refresher training in the modules.
  2. Review the RE-Certification Attestation Form. This will allow you to modify and bring up-to-date the information we have on file for your contact information, your agency’s street address, City and State, Zip for your main offices as well as any additional Names/Location of other clinics that are participating in Treat First.  You will need to complete the Medicaid ID and the NPI for each clinic, even if they are the same as your main facility.  Once you complete the from, please have the authorized person sign it attesting to the statements in the form.Again, you can either submit the form directly from the webpage, or download it and email it to  Treat.First@state.nm.us.
  3. Submit the RE-Certification Data Collection Training Request Form to Falling Colors at  support@bhsdstar.org. They will work with you directly to schedule a date in which they will train you on registration and data collection system. Insert that date in your Re-Certification Attestation Form.
  4. Upon receipt and approval of your Re-Certification Forms, a signed Certificate of Acknowledgement will be sent to your agency by the state.
  5. The state will notify both Falling Colors staff and the Medical Assistance Division designated staff who will update your Provide Profile that you are recertified as a Treat First Provider.

RE-Certification Attestation Form

RE-Certification Attestation Form

  • Name/Location of Facility SiteMedicaid IDNPI 
    Insert more if needed
  • The Provider Agency attests to the following activities:

  • Follow this link for the BHSDstar.org website.
    Follow this link for the TreatFirst.org website.
  • I attest to the accuracy of the above statements.

  • MM slash DD slash YYYY
  • Lead Treat First Contact (if different than above)

  • If you are downloading this form and intend to email it (instead of submitting it directly on the Treatfirst.org website) send the signed and completed Attestation form to Treat.First@state.nm.us

    Send the Data Collection Training Request form directly to support@bhsdstar.org

Data Collection Training Request Form

Data Collection Training Request Form

  • Name/Location of Facility SiteMedicaid IDNPI 
    (Insert more if needed)
  • Please enter a number greater than or equal to 1.

Downloadable Forms

  • RE-Certification Attestation Form

    RE-Certification Attestation Form

  • RE-Certification Data Collection Training Request Form

    RE-Certification Data Collection Training Request Form