Joining Provider Network / Forms / Provider Handbook
Provider Directory / Training / Billing FAQs / Tax Information
Note: This application is to apply to become a contracted provider for NorthernBridges only. Any federal, state, county, or professional licensures, certificates, or approvals required to provide your designated family care service or residential facilities service, must be acquired in addition to completing this application.
Adult Family Home Application
Claim Forms & Keys
Please download both of the following forms (claim form and key). The key contains necessary information to help you complete the claim form correctly for processing and payment.
Residential Facility Claim Form Excel / PDF
Residential Facility Claim Key Excel / PDF
Please download both of the following forms (claim form and key). The key contains necessary information to help you complete the claim form correctly for processing and payment.
Family Care Services Claim Form Excel / PDF
Family Care Services Claim Key Excel / PDF
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