Provider Report Documents
Basic Care Facilities:
- These reports may be downloaded for your convenience. Please submit a printed and signed copy of the completed report to the Department of Human Services' Provider Audit Unit by the appropriate deadline.
- The information provided will be used to establish rates beginning July 1, 2010.
- See the cover letter below for details.
- If you have questions, please contact Provider Audit at (701) 328-7560.
- Basic Care Facilities Cover Letter (70kb Word doc)
- Basic Care CPA authorization (13kb Word doc)
- Basic Care Facility Cost Report and Instructions (254kb Excel doc)
- Basic Care Facility Cost Report and Instructions - Printable (217kb Excel doc)
Note: One of the links above requires that you have Microsoft Excel on your computer. If you do not, you may download a free Excel viewer from the Microsoft web site.

