Step-by-Step Provider Enrollment Information
- Determine your provider type. Qualifications for enrollment for each provider type can be found here (pdf). Ensure you have the correct prerequisites completed.
- Determine the need for local services by your provider type in the area you want to serve. Contact the local System Point of Entry (SPOE) office found here in the area you want to provide First Steps services to determine if there is a need for your services in that location.
- Complete Module 1: Orientation if required for your provider type. If this module is required, you must successfully complete this free on-line training before you can enroll. For more information on this training, please visit the Module Training page.
- Your enrollment will not be final until you have completed Orientation and passed the assessment online.
- Results are forwarded to the CFO on a weekly basis.
- Determine if liability insurance is required for provider type. Contact your insurance provider to determine what is needed or, if you work for an agency, determine if you will be covered under your agency’s policy.
- Print out Provider Forms found here and complete:
- Service Provider Enrollment Checklist - Use as a guide in collecting information and submitting it for enrollment with the Central Finance Office (CFO).
- Service Provider Information Form - Complete all sections. "Site address" is the address that will be shown on the service matrix website. "Billing address" is the location where your payments are sent. If you work for an agency that cuts your check, put agency information in Billing Information section. If information is the same, can reference other completed sections.
- First Steps Service Provider Agreement - Review and complete name (and d/b/a or agency if appropriate) on the blank line on the first page; complete last page. If you work for an agency that gets the check from the CFO and then pays you, list the agency in the Payee Information section. For providers who require supervision, complete the "Supervision Required" Agreement. All other providers complete the "Specialist" Agreement.
- Lobbying, Debarment, Suspension Form - Read and complete workplace address under "Place of performance". Check the box if you will be serving children in the natural environment; write your name and Missouri First Steps under "Name of Applicant" and "PR/Award Number"; sign and date.
- Family Care Safety Registry - Submit per instructions online or via paper format.
- Medicaid/Medicare forms. Complete forms required for your provider type (listed on the enrollment checklist). Some forms cannot be made available online, so contact the CFO if your provider type requires these.
- Certification Statement for Claims other than paper. Print two (2) page document, print payee name (ABC organization or Jane Smith), Provider or Agency official name and title; sign/date and provide SSN or Tax ID for agencies. Print name and phone number for who the Central Finance Office (CFO) should contact with claims questions.
- Electronic Signature. Complete information. Original signature required for submission to CFO.
- Online Access Request Form. Complete all sections. Be sure to keep own record of security word.
- W-9 form and EFT/Direct Deposit Authorization, if applicable.
- Background Check and and Fingerprinting
- All new First Steps providers will use 3M/Cogent to schedule an appointment for fingerprinting, but 3M/Cogent requires applicants to first register with the Missouri Automated Criminal History Site (MACHS) Fingerprint Portal at: www.machs.mo.gov
To register, on MACHS the applicant must provide specific identifying information, including:
- Registration Number: This four digit number will ensure that DESE returns the results to First Steps. If you are an applicant for First Steps, you must use 2298.
- Agency Name: MO First Steps Uncertified
- Once you have verified your agency information, enter your personal demographic data into the spaces provided. For more information go to: http://www.dese.mo.gov/eq/cert/eq-cert-fingerprint-background.htm
- Once you have verified that the information that you have entered is correct, click “Schedule Fingerprinting” to schedule an appointment with 3M/Cogent.
For Family Member Transportation: Complete Family Member Transportation Checklist of items.
Send all forms to the Central Finance Office (CFO)
- For questions regarding these forms, please contact the Central Finance Office Provider Enrollment at 1-866-711-2573 (ext. 2). The address to mail these forms to is:
Provider Enrollment/CSC Attn: Missouri Provider Enrollment
P.O. Box 29134
Shawnee Mission, KS 66201-9134
- Once your enrollment has been processed, the CFO will mail you a letter confirming your enrollment and provide you with instructions on completing the Provider Service Matrix.
You may begin providing services once you receive confirmation that all forms have been completed. Your enrollment as a First Steps provider is subject to acceptable results from the background and fingerprint checks.
- Fill out the Provider Service Matrix. Newly enrolled providers have 15 days from notification of enrollment to complete their Matrix information.
- After you are on the Provider Service Matrix, you will be able to accept authorizations and bill for services provided. For more information on billing, please visit: http://dese.mo.gov/se/fs/ProviderResourcepg.html.
- Complete all other required training modules for your provider type. Once you are enrolled, you will have six months from your date of enrollment to complete all required training modules. Please view the Training Requirements document to determine which, if any, additional trainings are required for your provider type. These trainings do not have to be completed before you can begin to provide services. Modules are available for online completion at www.dese.mo.gov/divspeced/FirstSteps/moduletraining.html.
- After initial data entry, all providers must login to the Matrix and review/update the information every three (3) months. The Matrix includes a field for the date of the last update. That field will be monitored at the CFO and failure to update at least every three (3) months will result in the posting of a notice on the individual’s Matrix page to inform viewers that the provider’s availability may no longer be valid. Continued failure to update the Matrix will result in removal from view of the provider’s information and no new authorizations for that provider will be permitted at the CFO.