Provider Portal

Provider PortalBarnabas Helmy2025-11-13T11:35:20-06:00

Approved service provider portal for application submission:

Agency Provider Assistance

If you have questions regarding the ICC program, please fill out the form below.

NOTE: This contact form is for Referring Agencies only. All other inquiries should be placed here.

Name *

First

Last *

Last

Email *

Phone *

Agency Name *

Agency Type *

Area Agency on Aging (AAA)

AAA-Funded Entity

Community Care Program Care Coordination Unit (CCP-CCU)

Adult Day Service (ADS)

Adult Protective Services (APS)

Home Care Ombudsman (HCO)

Question Type *

Referring Agency Code

Equipment/Device Availability

General Program Questions

Technical Assistance

Referral Mistake (Please include participant name or referral number.)

OtherOther

Please provide details regarding your question: *

Captcha

If you are human, leave this field blank.

IATP ICC Program Hours: Monday-Friday, 8:00 A.M. to 4:30 P.M.

ICC Program Hours: Monday-Friday, 8:00 A.M. to 4:30 P.M.