Provider Enrollment Forms for Specialists
All required forms for new providers (Specialists) enrolling in Missouri First Steps are listed below:
Service Provider Enrollment Checklist
Service Provider Information Form (pdf and fill-form )
Service Provider Agreement (Specialist)
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
IMPORTANT: For Assistive Technology Provider, Audiologist, Counselor, Dietician, Nurse (RN and LPN), Optometrist, Ophthalmologist, Physician, Psychologist, and Social Worker - Contact Provider Enrollment at 1-866-711-2573 (Ext. 2) for required Medicaid forms not provided above.