Telecommunication Assistance Program (TAP) Hearing Aid Assistance (HAA) Vendor Information

• Certified audiologists and licensed hearing aid providers that are interested in providing financial assistance to a person that qualifies for the TAP program.
• Certified audiologists and licensed hearing aid providers that complete the necessary paperwork to become a DHS vendor to receive payments.

TAP HAA providers that have not done business with WI Dept. of Health Services in the past will need to submit the following forms:

• DOA-6460: NEW Supplier Form. (This is a form a provider will need to complete to be added into the Wisconsin accounts payable system to receive payments. The form has sections for Tax ID # (FEIN), Legal Business Name, Date of Birth, Address, Direct Deposit Payment information, and Contact Information. A signature is required on the form.) Providers should contact the TAP program to request a DOA-6460: New Supplier Form
• IRS-W9 Form
• Bank Verification. (A copy of a current voided check or a bank letter on bank letterhead, signed by a bank representative. Each must include the individual/company name, routing, and account numbers.)

The TAP program processes the paperwork through the department's accounting system and a unique vendor ID is assigned so the provider can begin invoicing the program.

Please feel free to contact the TAP Program Coordinator by email to find out if your agency is already an approved DHS vendor.

Each applicant will need to provide the following information to apply for TAP HAA:

• An online application or printable application form, F-02306.
• A completed hearing loss certification form, F-22554, signed by a certified audiologist or licensed hearing aid provider within the last six months.
• A quote from their provider noting the T-coil or Bluetooth program is included and enabled, along with the total purchase amount.

Please note: Program funding is not intended to cover costs associated with repairs, batteries, hearing exams, other clinical or office expenses, medical expenses, or past purchase amounts.

The financial assistance vouchers will be mailed to the applicants or an applicant's legal representative to be redeemed with the approved vendor as a credit towards the total purchase price.

Applicants will need to sign the vouchers to transfer the value to the providers as a credit towards their hearing aid or processor purchase.

The providers will invoice the TAP program for the voucher amount.

Once a provider has been approved and entered into the Wisconsin accounting system, they are able to invoice the program for voucher payments.

To invoice the program the vendor should send invoices to dhsbadrinvoices@dhs.wisconsin.gov.

Each invoice will need to include:

• Invoice date
• A unique invoice number
• Vendor's name and address
• Accurate description of charges (example: for TAP HAA voucher # XXXX)
• Voucher dollar amount
• Invoice total

Along with the invoice the providers will need to include:

• A copy of the applicant's signed/redeemed voucher
• A copy of the final bill of sale noting the T-coil or Bluetooth programming and the amount of the voucher was subtracted from the total amount paid.

Invoices will be processed per DHS's accounting practices and fiscal processing within 30 days of the date the invoice is received.