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.

Provider Newsletter:
2023 Provider Newsletter

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:
IOP Request Form
Psychological Testing Request Form
TMS Request Form (Electronic fillable version)
TMS Request Form (Printable version)
ABA Treatment Request Form

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

Medical Necessity Criteria:
Mercy Managed Behavioral Health utilizes nationally recognized medical necessity criteria (as contractually required) and clinical practice guidelines. Our Medical Directors and clinical staff apply community standards of care as well as individual clinical needs in our care decisions. A copy of the specific medical necessity criteria used in our UM decisions is available by mail, fax, or secure email upon request.