Provider Report Documents
Nursing Home 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 January 1, 2013.
- See the cover letter below for details.
- If you have questions, please contact Provider Audit at (701) 328-7560.
- Nursing Facility Cover Letter
- NH-CPA Authorization (13kb doc)
- Nursing Facility Cost Report and Instructions
- Nursing Facility Cost Report and Instructions Printable
- Nursing Facility Reconciliation (10kb xls)
Note: The links above require that you have Microsoft Excel on your computer. If you do not, you may download a free Excel viewer from the Microsoft web site.

