Arizona Independent Provider Program (DDD) Documents

For Members/Employers

• AZ Power Of Attorney
• AZ 285 General Disclosure/Representation Authorization
• AZ 285B Disclosure Authorization
• Employer Of Record Request Form
• Employer Packet
• Designated Representative

For Independent Providers

• Employment Packet
• Direct Deposit Instructions
• Direct Deposit Application
• Provider's Withholding Allowance Certificate IRS FORM W-4
• Provider's AZ Withholding Percentage Election FORM A-4
• USCIS Form I-9
• USCIS Form I-9 Instructions
• USCIS Form I-9, Spanish (FOR REFERENCE ONLY)
• USCIS Form I 9 Instructions, Spanish (FOR REFERENCE ONLY)
• Checklist To Complete I-9 Form
• Instructions To Complete I-9 Form

Program Resources

• Independent Provider Program Training For Support Coordinators And Network Staff
• Payment And Pend Management Process For Independent Providers
• Public Partnerships Claims Dispute Policy For Independent Providers
• IP Claim Dispute Template (PDF)
• IP Claim Dispute Template (Excel)

Timesheet Information

• Payroll Schedule For GROUP A
• Payroll Schedule For GROUP B
• Timesheet Instructions
• Timesheet
• Timesheet (With Text Boxes)

Online Timesheet Information- BetterOnline™ Portal

• How To Register On The BetterOnline Web Portal
• PPL Web Portal How To Submit Timesheets
• PPL Web Portal How To Approve Timesheets
• Public Partnerships Web Portal Timesheet Status Definitions
• Web Portal Service Type Descriptions

*Some of the above links may take you to third-party operated websites.