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Missouri Care Providers can access important forms below.Use the links below to download mental health provider forms. A short description of each form is listed at the bottom of this page. Most forms are available in two formats.
  • Select the .pdf format if you wish to print the form and complete it by hand.
  • Select the MS Word Fillable Form format if you wish to complete the form on your computer and then print the computer-generated form. Once the form is open, use the 'Tab' keys on your computer to move from field to field and type the requested information in each field. You can then save and/or print using your normal processes. (Your computer must have Microsoft Word to use this format.)

Mental Health Provider Forms

Behavioral Health Case Management Request Form- .pdf format

PCP Notification Form- .pdf format

Provision of Outpatient Services Notification Form- .pdf format

Medication Management Request Form (for over 8 units)- .pdf format

Outpatient Treatment Request Form (for over 10 units)- fillable form

Outpatient Treatment Request Form (for over 10 units)- .pdf format

Provision of Outpatient Services Notification Use this form to notify Missouri Care Behavioral Health of outpatient services that do not need prior authorization but are subject to notification prior to claims submission. (Mental health providers do not need a pre-authorization for the first 20 units of routine outpatient therapy or the first 8 units of psychiatric medication management - per member, per year. However, notification is required prior to claims submission. See the Provider Manual for specific further information about these services.

Outpatient Treatment Request Form (for over 20 units)

This form is a quick and easy way for mental health providers to request approval for outpatient and intensive outpatient services. You can use these forms for all prior authorization requests as long as:
  • You are an in-network provider.
  • You are not requesting approval for a procedure scheduled to take place the next business day.
  • You are not requesting authorization for an inpatient or residential admission.

Requests from an out-of-network provider for admissions and for procedures scheduled to take place the next business day, need to be completed by phone. You can reach our Prior Authorization department by phone at 800-889-4073 or by fax at 866-543-2385

PCP Notification Form

Mental health providers are required to communicate with the member's primary care providers (PCP), unless it is documented that the member declines to sign a release of information. Please inform the member that coordination of his or her care with the PCP is critical to the integration of mental health and medical care. This communication to the PCP assists in avoiding medication incompatibility and alerts the PCP to the behavioral health needs of the patient. Use this form to communicate with the PCP at the time of admission, discharge and any significant changes in the member's treatment plan or medication regime.