GT Independence 215 Broadus Sturgis, MI 49091 8776594500 wwwgtindependencecom Your life Your choice November 2017 Dear Caregiver, As you continue to provide excellent care to the people you serve, we too continuously strive to improve the quality of the services we provide We hope you find the enclosed items helpful 2018 Payroll Schedule Please find your 2018 Payroll Schedule enclosed and review it carefully Please remember that timesheets can be submitted 24 hours/day, 7 days/week even on holidays! You can be alerted via text or e-mail that your timesheet has been received Alerts are also sent if the timesheet is unable to be processed due to an error so that you can correct the issue and avoid delays in payment Ask a Customer Service Representative for more details! Telehealth Information We have included information about an optional service called Telehealth This service is available to you at a low cost if you choose to participate GT Independence Portal and Online Timesheets Our secure portal allows you to view your pay stubs, print blank timesheets, check the Payroll Schedule, as well as submit Customer Service requests You can also now submit timesheets online through the portal! Caregiver Survey Please take a moment to complete and return the enclosed survey Your valuable feedback helps us to provide the highest quality services for self-directed care Thank you! The holiday season is a time to reflect upon the things for which we are thankful Thank you for continuing to provide care to the people you serve Because of providers like you, more and more people are able to live an independent lifestyle of their choosing Thank you If you have any questions regarding this letter please feel free to contact our customer service department at customerservice@gtindependencecom, or by phone at 1-877-659-4500 Thank you, Customer Service Department GT Independence 215 Broadus St, Sturgis, MI 49091 PHONE 8776594500 TIMESHEET FAX 8553298648
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Page 2 of 4 11/25/2012 Para informacion en espanol, visite wwwconsumerfinancegov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street NW, Washington, DC 20006 A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records) Here is a summary of your major rights under the FCRA For more information, including information about additional rights, go to wwwconsumerfinancegov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street NW, Washington, DC 20006 You must be told if information in your file has been used against you Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information You have the right to know what is in your file You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure") You will be required to provide proper identification, which may include your Social Security number In many cases, the disclosure will be free You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies See wwwconsumerfinancegov/learnmore for additional information You have the right to ask for a credit score Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it In some mortgage transactions, you will receive credit score information for free from the mortgage lender You have the right to dispute incomplete or inaccurate information If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous See wwwconsumerfinancegov/learnmore for an explanation of dispute procedures Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days However, a consumer reporting agency may continue to report information it has verified as accurate Consumer reporting agencies may not report outdated negative information In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old Access to your file is limited A consumer reporting agency may provide information about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business The FCRA specifies those with a valid need for access You must give your consent for reports to be provided to employers A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer Written consent generally is not required in the trucking industry For more information, go to wwwconsumerfinancegov/learnmore You may limit "prescreened" offers of credit and insurance you get based on information in your credit report Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on You may opt-out with the nationwide credit bureaus at 1-888-567-8688 You may seek damages from violators If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court Identity theft victims and active duty military personnel have additional rights For more information, wwwconsumerfinancegov/learnmore
Page 3 of 4 11/25/2012 States may enforce the FCRA, and many states have their own consumer reporting laws In some cases, you may have more rights under state law For more information, contact your state or local consumer protection agency or your state Attorney General For information about your federal rights, contact: TYPE OF BUSINESS: 1a Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates b Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau: 2 To the extent not included in item 1 above: a National banks, federal savings associations, and federal branches and federal agencies of foreign banks b State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d Federal Credit Unions CONTACT: a Bureau of Consumer Financial Protection 1700 G Street NW Washington, DC 20006 b Federal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 (877) 382-4357 a Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 b Federal Reserve Consumer Help Center PO Box 1200 Minneapolis, MN 55480 c FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA 22314 3 Air carriers Asst General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590 4 Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423 5 Creditors Subject to Packers and Stockyards Act Nearest Packers and Stockyards Administration area supervisor 6 Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416 7 Brokers and Dealers Securities and Exchange Commission 100 F St NE Washington, DC 20549 8 Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090 9 Retailers, Finance Companies, and All Other Creditors Not Listed Above FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 (877) 382-4357
GT Independence Caregiver Link Application INTERNAL USE ONLY DATATRAC File Dear Caregiver: Do you have an interest in additional work hours? GT independence has a resource tool called Caregiver Link, which is an online caregiver directory The directory works to connect individuals seeking provider services and supports with potential people who enjoy working in the care giving field Please complete the information below and return this form to GT by fax at 8889723891 to be added to our caregiver directory Your completion of this form does not guarantee employment, however it may provide you with an opportunity to provide Self-Directed supports for one or more additional people GT Independence encourages you to meet and interview with any opportunities that you may receive to provide supports for additional people Application Please print NAME: ADDRESS: (Street address, city, state, zip code) PHONE NUMBER(S): EMAIL ADDRESS: Are you at least 18 years old? Medicaid funding requires you to be a minimum of 18 years old Circle one: YES / NO Do you have your own transportation? Circle one: YES / NO Do you have experience working with people who have a disability? Circle one: YES / NO When are you able to work? Circle all that apply: DAYS / NIGHTS / WEEKENDS Please note the days you are unavailable to work Have you ever been convicted of a felony or misdemeanor? Circle one: YES / NO By signing this application you are consenting to GT Independence sharing your name and phone number with potential individuals needing services/supports, and Care Managers with Managed Care Organizations Employee Signature Date
GT Independence Timesheet Notification Registration GT Independence can notify you of the receipt of your timesheet by sending an email notification or SMS (Short Message Service) text message To sign up for this notification service, please fill out the information below and submit via: Mail: 215 Broadus St Sturgis, MI 49091 Fax: 888-972-3891 E-mail: customerservice@gtindependencecom Please print clearly Employee Name: Agency: I Provide Services For (Participant Name): Method of Notification: E-mail: Cell Phone #: E-mail OR SMS Text Message Provider(Cell Phone Company): Please allow two to four weeks for processing Once activated, notifications will be sent within 2 business days of receipt of the timesheet This notification does not guarantee the timesheet will be paid, only that it has been received GT Independence will contact the appropriate parties if the timesheet cannot be processed By signing below, I agree to not hold GT Independence responsible for the privacy of the message or any text message/data rates that may be incurred Employee Signature Date To cancel notifications, please submit a completed Status Change Form, available by contacting Customer Service at 877-659-4500
IRIS Timesheet Submission Guidelines Timesheet Submission: Fax: 855-FAX-TO-GT or 855-329-8648 E-mail: iris@gtindependencecom Mail: 215 Broadus St Sturgis, MI 49091 Did you send your timesheet in on time? You do not have to wait for the due date to send in your timesheets Our fax machines and e-mail system can accept faxes 24 hours/ day, 7 days/week Refer to the payroll schedule to assure you are submitting your timesheet on time Timesheets cannot be submitted before all of the hours are worked Late timesheets will be paid on the following pay period Please contact Customer Service with any questions, 1-877-659-4500 Are your timesheets legible? Take your time in completing your timesheet Please print clearly in blue or black ink Have you filled in the pay period dates at the top of your timesheet? Please refer to the payroll schedule you have been provided for the correct payroll period Have you included all of the time worked for this payroll period? Did you work all of the hours you submitted? It is fraudulent to report hours you did not work You cannot report hours while the member you are providing services for is hospitalized or in a medical facility (ie hospital, nursing home, rehab) Did you report your time in the correct format and include AM and PM? You need to report time in fifteen minute increments For example, 8:06 AM 10:35 AM should be reported as 8:15 AM 10:30 AM Each fifteen minute increment is equal to one quarter of an hour 25 hours = 15 minutes, 50 hours = 30 minutes, 75 hours = 45 minutes Does your time in and time out equal the hours reported for each day? Did you include the correct service code for each day worked? The employee folder provided to you includes the correct service code information If you are unsure about which service code you should be using please contact Customer Service at 877-659-4500 Did you total your hours at the bottom of your timesheet for the current pay period? Did you make sure not to use white out on your timesheet? If you make an error on your timesheet you should correct it by drawing a single line through it Both the employer and employee should date and initial the correction Did you fully complete each section of the timesheet? You may not draw lines, arrows, or use ditto marks to complete sections of your timesheet Each section must be completed even if the information is the same Did the employee and employer both sign and date the timesheet with month, date, and year on or after the last date worked? Be sure that your timesheet is signed by the Employer and the Employee along with the date The date must be the complete date with month, date, and year and be on or after the last date worked If you needed to resubmit a timesheet did you write REFAX at the top of the timesheet? Did you report more hours than authorized? Your timesheet may be delayed if you report more hours than you were approved to provide GT Independence Customer Service 877-659-4500
S e l f D e t e r m i n a t i o n T i m e s h e e t S e r v i c e C o d S e r v i c e C o d S e r v i c e C o d S e r v i c e C o d P a r t i c i p a n t - H i r e d W P a r t i c i p a n t : Total Hours - 1 S e r v i c e C o d e S e r v i c e C o d e S e r v i c e C o d e S e r v i c e C o d e Period Begins: Period Ends: S U B M I T T I M E S H E FAX: 855-329-8648 Email: iris@gtindependencecom Mail: GT Independence 215 Broadus St Sturgis, MI 49091 Please call GT Independence at 877-659-4500 with any questions on how to complete this form Total Hours - 2 T h e P a r t i c i p a n t E m p l o y e r / G u a r d i a n W o r k e r c e r t i f y t h a t t h e i n f o r m a t i o n r e p o r t i s a t r u e a n d a c c u r a t e s t a t e p r o v i d e d T h e P a r t i c i p a n t E m p l o y P a r t i c i p a n t H i r e d W o r k e r u n d e r s t a n s e r v i c e s p r o v i d e d a r e t h e s u b j e c P a r t i c i p a n t - H i r e d W o r k e D a t e : / D a t e : / P a r t i c i p a n t / S u p e r v i s o r
Self Determination Timesheet Service Code Service Code Service Code Service Code Participant-Hired Worker: Participant: Total Hours - 1 Total Hours - 2 Service Code Service Code Service Code Service Code Period Begins: Period Ends: Date: / / SUBMIT TIMESHEETS FAX: 855-329-8648 Email: iris@gtindependencecom Mail: GT Independence 215 Broadus St Sturgis, MI 49091 Please call GT Independence at 877-659-4500 with any questions on how to complete this form The Participant Employer/Guardian and Participant Hired Worker certify that the information provided on this time report is a true and accurate statement of the services provided The Participant Employer/Guardian and Participant Hired Worker understand that payment for services provided are the subject to payroll taxes Participant-Hired Worker Signature: Date: / / Participant/Supervisor Signature:
Self Determination Timesheet Service Code Service Code Service Code Service Code Participant-Hired Worker: Participant: Total Hours - 1 Total Hours - 2 Service Code Service Code Service Code Service Code Period Begins: Period Ends: Date: / / SUBMIT TIMESHEETS FAX: 855-329-8648 Email: iris@gtindependencecom Mail: GT Independence 215 Broadus St Sturgis, MI 49091 Please call GT Independence at 877-659-4500 with any questions on how to complete this form The Participant Employer/Guardian and Participant Hired Worker certify that the information provided on this time report is a true and accurate statement of the services provided The Participant Employer/Guardian and Participant Hired Worker understand that payment for services provided are the subject to payroll taxes Participant-Hired Worker Signature: Date: / / Participant/Supervisor Signature:
Self Determination Timesheet Service Code Service Code Service Code Service Code Participant-Hired Worker: Participant: Total Hours - 1 Total Hours - 2 Service Code Service Code Service Code Service Code Period Begins: Period Ends: Date: / / SUBMIT TIMESHEETS FAX: 855-329-8648 Email: iris@gtindependencecom Mail: GT Independence 215 Broadus St Sturgis, MI 49091 Please call GT Independence at 877-659-4500 with any questions on how to complete this form The Participant Employer/Guardian and Participant Hired Worker certify that the information provided on this time report is a true and accurate statement of the services provided The Participant Employer/Guardian and Participant Hired Worker understand that payment for services provided are the subject to payroll taxes Participant-Hired Worker Signature: Date: / / Participant/Supervisor Signature:
Self Determination Timesheet Service Code Service Code Service Code Service Code Participant-Hired Worker: Participant: Total Hours - 1 Total Hours - 2 Service Code Service Code Service Code Service Code Period Begins: Period Ends: Date: / / SUBMIT TIMESHEETS FAX: 855-329-8648 Email: iris@gtindependencecom Mail: GT Independence 215 Broadus St Sturgis, MI 49091 Please call GT Independence at 877-659-4500 with any questions on how to complete this form The Participant Employer/Guardian and Participant Hired Worker certify that the information provided on this time report is a true and accurate statement of the services provided The Participant Employer/Guardian and Participant Hired Worker understand that payment for services provided are the subject to payroll taxes Participant-Hired Worker Signature: Date: / / Participant/Supervisor Signature:
GT Independence 2018 Payroll Schedule IRIS Pay Period: Timesheets Due by 5:00 pm: Payment Date: Nov 12 Nov 25, 2017 day, December 1, 2017 day, December 15, 2017 Nov 26 Dec 9, 2017 day, December 15, 2017 day, December 29, 2017 Dec 10 Dec 23, 2017 day, December 29, 2017 day, January 12, 2018 Dec 24, 2017 Jan 6, 2018 day, January 12, 2018 day, January 26, 2018 Jan 7 Jan 20 day, January 26, 2018 day, February 9, 2018 Jan 21 Feb 3 day, February 9, 2018 day, February 23, 2018 Feb 4 Feb 17 day, February 23, 2018 day, March 9, 2018 Feb 18 Mar 3 day, March 9, 2018 day, March 23, 2018 Mar 4 Mar 17 day, March 23, 2018 day, April 6, 2018 Mar 18 Mar 31 day, April 6, 2018 day, April 20, 2018 Apr 1 Apr 14 day, April 20, 2018 day, May 4, 2018 Apr 15 Apr 28 day, May 4, 2018 day, May 18, 2018 Apr 29 May 12 day, May 18, 2018 day, June 1, 2018 May 13 May 26 day, June 1, 2018 day, June 15, 2018 May 27 Jun 9 day, June 15, 2018 day, June 29, 2018 Jun 10 Jun 23 day, June 29, 2018 day, July 13, 2018 Jun 24 Jul 7 day, July 13, 2018 day, July 27, 2018 Jul 8 Jul 21 day, July 27, 2018 day, August 10, 2018 Jul 22 Aug 4 day, August 10, 2018 day, August 24, 2018 Aug 5 Aug 18 day, August 24, 2018 day, September 7, 2018 Aug 19 Sept 1 day, September 7, 2018 day, September 21, 2018 Sept 2 Sept 15 day, September 21, 2018 day, October 5, 2018 Sept 16 Sept 29 day, October 5, 2018 day, October 19, 2018 Sept 30 Oct 13 day, October 19, 2018 day, November 2, 2018 Oct 14 Oct 27 day, November 2, 2018 day, November 16, 2018 Oct 28 Nov 10 day, November 16, 2018 day, November 30, 2018 Nov 11 Nov 24 day, November 30, 2018 day, December 14, 2018 Nov 25 Dec 8 day, December 14, 2018 day, December 28, 2018 Dec 9 Dec 22 day, December 28, 2018 day, January 11, 2019 Dec 23 Jan 5, 2019 day, January 11, 2019 day, January 25, 2019 Please remember the following about your timesheets: Please review the Timesheet Submission Guidelines to assure your timesheet is complete Timesheets must be completed with blue or black ink Timesheets are to be signed and dated by the employee and the employer Signature dates should be in format Must be completed with printed employer and employee names, dates, times and service type Only one entry is allowed per row on the time sheet - submit multiple timesheets if necessary Incorrect timesheets will require resubmission of corrected timesheets and will delay payment All resubmissions are required to have REFAX written at the top of the timesheet When working for multiple employers, you must turn in a timesheet for each employer Late timesheets will be held until the following pay period White-out, ditto marks or lines drawn down the columns are not permitted You cannot submit time when the person receiving services is in the hospital Timesheets are accepted by e-mail and fax 24 hours per day, 7 days per week even on holidays Fax your timesheets to 855-FAX-TO-GT (855-329-8648) Timesheets are accepted by email at iris@gtindependencecom Timesheets accepted online at portalgtindependencecom For assistance call Customer Service at 877-659-4500 The office will be closed on the following days: rsday, November 23, 2017 day, November 24, 2017 day, December 25, 2017 sday, December 26, 2017 day, January 1, 2018 day, May 28, 2018 nesday, July 4, 2018 day, September 3, 2018 rsday, November 22, 2018 day, November 23, 2018 day, December 24, 2018 sday, December 26, 2018 sday, January 1, 2019 ***If your timesheet requires a refax or resubmission your payment will be delayed ***Timesheets submitted that are over the authorized amount may not be eligible for payment Please only submit time that has been authorized