You are on the path to becoming a provider for the Department of Mental Health and below you will find the forms needed to enroll as a Medicaid provider for the Department.
Once you have completed the forms and you have gathered all of the required information, you will send the forms to Missouri Medicaid Audit and Compliance by one of the methods listed below.
All forms come with instruction on how to complete the form. It is important that all questions are answered and the forms have original signatures and date before returning them to MMAC.
Any questions about the forms or how to complete the forms shall be directed to MMAC.
You may reach them by the e-mail listed above or by phone at (573) 751-3399.
MMAC will contact you via e-mail if and when any additional information is required during your enrollment. It is very important that you watch your e-mail closely as the correspondence will be time sensitive.
The forms below are provided for your convenience to update information after your enrollment has been completed with MMAC. Return completed forms to MMAC for information to be updated.
If you have had a change or an addition in managing employees, complete the form below.
For a primary, billing and mailing address, or phone number change, complete the form below.
For a change in your bank routing number or bank account number, complete the form below.
MMAC will contact you via e-mail when the change is complete or to request additional information.
