Information for Providers

Our site is under construction, so please excuse the mess

This page is intended for Providers of treatment and/or support services. Here Providers will be able to find or link to FYI Fridays, Training Opportunities/Guidance documents, Forms, Resources, Program specific pages and more.

Click Here for the Community Provider Bulletin Board

 

Specialized Treatment Programs and Services - Provider Information

Information for Providers

Information for the General Public

Provider Forms

Forms

For more information, please phone us at (573) 751-4942 or e-mail us at adamail@dmh.mo.gov.

Allocation Transfer Request Forms

Clinical Utilization Forms 

Requests for clinical utilization review of services provided after October 1, 2007, must be completed in CIMOR. These forms are being made available to facilitate intra-agency communication of clinical review information and should not be submitted to the Division for review. 

Compulsive Gambling Treatment Forms

CIMOR

CPS Status Report

Organization Change Forms

Form to be used by providers to change their organization's information (site addresses, services provided, director name, etc.)

SCL Referral Packets

  • Adult SCL Referral Packet - This packet is for adult placements only. Please contact your respective regional office for approval and any additional requirements.
  • Youth SCL Referral Packet - This packet is for youth placement only. Please contact your respective regional office for approval and any additional requirements prior to placement.

Women's & Children's CSTAR Program Forms

MO HealthNet Managed Care Protocol for Pregnant Women. The following forms are available for use by the Women & Children’s CSTAR programs that are participating in the Substance Abuse Treatment Referral Protocol for Pregnant Women Under MO HealthNet Managed Care.

Other

ACI Quarterly Report Form installation instructions

Metabolic Syndrome Screening and Monitoring Tool

CPS Status Report

CPS Status Report - Spanish Translation

Block Grant Information
Diagnosis Mapping

Posted below are three documents that contain the CPS Adult CPR, CPS Youth CPR, CPS DLA, CPS Youth DLA, ADA CSTAR, ADA CSTAR Detox, and ADA Pre and Post Test Counseling (HIV, TB) diagnosis group mapping. This mapping includes the DSM-5 and ICD-10 codes.

CIMOR requires ICD-10 Diagnoses in Episodes of Care for admissions effective 10/1/2015 and later, and for billing in Medicaid eligible programs for dates of service 10/1/2015 and later. DSM-5 diagnoses may be added to CIMOR, and mapping to ICD-10 will be available if there is a one-to-one relationship.

Medicaid Eligibility

In order to help DMH Agencies and Providers in assisting consumers with applying and keeping their Medicaid (MO HealthNet) coverage, the DMH Medicaid Unit has created this page to provide easy access to needed documents, answered frequently asked questions, and generally provide information about Missouri’s Medicaid program: Medicaid Eligibility  

Department of Mental Health agencies and providers may contact  us at  DMH.MedicaidEligibility@dmh.mo.gov with any questions about Medicaid Eligibility, case status, MO HealthNet policy, or other matters relating to DMH consumers and MO HealthNet.

Guidance for Substance Use Treatment
Information for Providers