Completing the Live-In Attestation Form 📝

Hi there!

I'm, Ansh and, one of the owners at Cova Home Care.

Today I'll be walking you through the Caregiver Live-in Attestation form.

And the purpose of this form is to let the state know that you, as the caregiver, live with your patient.

So you don't have to deal with that annoying clock in and clock out that we'd normally have to do with the EVV system.

So we're going to begin with section one, which asks for your information as the caregiver.

You're going to go ahead and click and check box one.

After that, as you can see with my pre filled information as an example, you're going to go ahead and write down your first name, last name, street address, city, state, and zip code, as well as your email address, phone number, and CHAMPS provider ID number.

Now, if you're an agency transfer, you would have already been set up with this provider ID number.

But if you're a new enrollment and started with Cova from scratch, you would have been provided this number by us already.

Then section two, we're going to fill in the patient's information.

So you go ahead and write down the patient's first name, last name, and Medicaid ID number.

And then you write down the patient's street address, city, state, and zip code.

The street address will probably be the same as the one of yours because this is the Live-in Attestation form.

And then right below we check the box that says home help.

After that, all there is is section three.

You go ahead and, in wet ink, you sign right over here.

And then you also date this.

That's all there is to this form.

There's nothing else to do.

The rest is done by the state.

What you have to do is send us a clear image of this form and send it to our secure phone number, which is 734-707-7330.

And as always, if you have any questions or any concerns, please don't hesitate to reach out.

Take care.

Bye bye.