Enrollment Forms for Providers Requiring Supervision
All required forms for new providers requiring supervision and enrolling in Missouri First Steps are listed below:
Service Provider Enrollment Checklist
Service Provider Information Form (pdf)
Service Provider Agreement (Supervision Required)
Background and Fingerprinting Check Procedures
Scheduling a Fingerprinting Appointment
Lobbying, Debarment, Suspension Form
Medicaid/Medicare Provider Information
Certification for Online Claims
User Online Access Request Form (pdf and fill-form)
EFT/Direct Deposit Authorization