Provider Report Documents
Psychiatric Residential Treatment 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.
- Reports should be completed as indicated in NDAC 75-02-09. The information provided will be used to establish rates beginning January 1, 2013.
- Reports are due within three months of your fiscal year end.
- For further details contact Provider Audit at (701) 328-7560.
- Psychiatric Residential Treatment Facility Cover Letter
- Psychiatric Residential Treatment Facility Cost Report and Instructions
- Psychiatric Residential Treatment Facility Cost Report and Instructions - Printable
- Psychiatric Residential Treatment Facility CPA Authorization - Printable/Fillable (14kb 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.

