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Provider Enrollment Forms

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All forms needed for the following First Steps provider types:


Specialists 

Includes: ABA Consultant, Assistive Technology Provider, Audiologist, Counselor, Dietician, Interpreter, Nurse (RN and LPN), Occupational Therapist, Optometrist, Ophthalmologist, Orientation and Mobility Specialist, Physical Therapist, Physician, Psychologist, Special Instructor, Speech/Language Pathologist, Social Worker, Translator, and Transportation Provider

All required forms for new providers (Specialists) enrolling in Missouri First Steps are listed below:

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.

Providers Requiring Supervision

Includes: ABA Implementer, Occupational Therapy Assistant (COTA), Paraprofessional, Physical Therapist Assistant (PTA), and Speech/Language Pathology Assistant (SLPA)

All required forms for new providers requiring supervision and enrolling in Missouri First Steps are listed below:

Parents/Family Members

All required forms for new family members who enroll in Missouri First Steps to provide transportation are listed below:

Service Coordinators

All required forms for Service Coordinators who enroll in Missouri First Steps are listed below:

IMPORTANT: For new System Point of Entry (SPOE) contractors, documentation of the SPOE Agency must be on file prior to Service Coordinator enrollment. Complete the documentation required for SPOE agencies on the SPOE Agency Enrollment Checklist