Provider Service Agreement

A document that outlines the services that the SC/PA has authorized for any provider to deliver. A complete ISP can substitute for the Service Agreement form when the chosen provider has signed the ISP and been given a copy. The Service Agreement form must always be used when a PSW is selected to provide services. The Service Agreement can be used for any provider when the person has not given their permission to share the ISP document with a provider. Any provider who has a Medicaid provider number (i.e. is enrolled in eXPRS) must have a signed ISP or Service Agreement form for each service they are paid to deliver.