Practice Improvement Resource Center (PIRC)
Manuals
Physical Health Forms
- Hearing Aid Authorization Request MS-76 (search MS-76)
- Home Care Electronic Visit Verification (EVV) Self-Registration and Netsmart Training Information (PDF)
- Home Health Authorization Request MS-72 (search MS-72)
- Informed Consent for Hysterectomies and Completion Instructions (PDF)
- Inpatient Medicaid Prior Authorization (PDF) (01/30/2024)
- Dental Prior Authorization List (PDF)
- Notification of Pregnancy NOP (PDF) for provider use (04/18/2024)
- Outpatient Medicaid Prior Authorization (PDF) (01/01/2025)
- Outpatient Treatment Request (OTR) Tip Sheet (PDF)
- PCP Change Request (PDF) for provider use (effective 01/01/2024)
- Physician's Report on Hearing Loss DM-5H (search DM-5H)
- Provider Claim Appeal (PDF)
- Provider Reconsideration (PDF)
- PT/OT/ST Authorization FAQ (PDF)
- PT/OT/ST Authorization Tips
- PT/OT/ST Authorization Transition Training Presentation (PDF)
- PT/OT/ST Outpatient Medicaid Prior Authorization (PDF) (01/01/2025)
- PT/OT/ST Supplemental Information Needed (PDF) (08/07/2019)
- Sterilization Consent Form and Completion Instructions (PDF)
- Sterilization Consent Form English (PDF)
- Sterilization Consent Form Spanish (PDF)
Behavioral Health Forms
- Applied Behavioral Analysis (ABA) Form (PDF)
- ABA Behavior Assessment and Plans Tip Sheet (PDF)
- ABA Caregiver Training Tip Sheet (PDF)
- ABA Coordination of Care Tip Sheet (PDF)
- ABA Medication Management Tip Sheet (PDF)
- ABA Outpatient Treatment Request (OTR) Tip Sheet (PDF)
- ABA Prescription Fulfillment Tip Sheet (PDF)
- ABA Transition Planning Tip Sheet (PDF)
- Behavioral Health Bulletins
- Certificate of Need for Psychiatric Residential Treatment Facility (PDF)
- Critical Incident Report Form (PDF)
- Disease Management Referral (PDF)
- Electroconvulsive Therapy (ECT) Form (PDF)
- Inpatient Medicaid Prior Authorization (PDF) (01/30/2024)
- Intensive Outpatient Mental Health/Chemical Dependency Form (PDF)
- Medicaid Rehab Option (MRO) Request (PDF)
- Neuro Psychological Testing OTR Form (PDF)
- Outpatient Medicaid Prior Authorization (PDF) (01/01/2025)
- Outpatient Treatment Request (OTR) General BH (PDF)
- Outpatient Treatment Request (OTR) Non-Par (PDF)
- Outpatient Treatment Request (OTR) Tip Sheet (PDF)
- Provider Claim Appeal Form (PDF)
- Provider Incomplete Information Fax (PDF)
- Provider Reconsideration Form (PDF)
- Wellness Plan (PDF)
General Provider Information
- DHHS Access Standards – Physical Health and Behavioral Health (PDF)
- DHHS Heritage Health Resources
- DHHS Provider Bulletin PB 15-54 Provider Screening and Enrollment - Maximus Information (PDF)
- DHHS Provider Bulletin PB 16-26 Continuity of Care (PDF)
- DHHS Provider FAQs (PDF)
- Enhanced Ambulatory Patient Groups (EAPGs) Training Overview (PDF)
- Incentives Statement
- Limitations on Provider Marketing (PDF)
- Managed Care Organization Dental FAQ for Providers (PDF)
- Maximus Provider Enrollment Portal
- Requesting Interpreter Services (PDF)
Dental Provider Information
- Centene Dental Services Provider Website (formerly Envolve)
- Centene Dental Services Provider Manual 2024 (PDF) (formerly Envolve)
- Centene Dental Services Provider FAQs (formerly Envolve)
- Dental Prior Authorization Request Codes
- Multi Encounter Procedure PPS Encounter Billing (PDF)
- Multi Encounter Exception Request Form (PDF)