Downloadable Resources for Providers

Looking to join our network?
Providers interested in joining Mercy Managed Behavioral Health’s Network, please complete the attached form and return it, along with a copy of your resume/CV. Please note that we do not credentialing provisional providers. You must be fully licensed and able practice independently in your state in order to be considered.

MMBH Provider Network Request Form

Are you an existing provider?
Below you will find forms utilized by Mercy Managed Behavioral Health, along with links to valuable resources.  For questions, please contact Provider Relations at (314) 729-4630.

Forms:
W-9 Form
Provider Manual
Provider Change Form
Claim Submission and Payment Addresses
Authorization for Disclosure
MMBH Clinical Practice Guidelines
Notice of Privacy Practices

Treatment Request Forms:
Psychological Testing Request Form
TMS Request Form
ABA Treatment Request Form

Resources:
Missouri Department of Mental Health
Centers for Medicare and Medicaid Services
National Clinical Practice Guidelines
ADHD Medication Guidelines
ADHD Screening Algorithm