Provider Enrollment Forms
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:
- Service Provider Enrollment Checklist
- Service Provider Information Form
- Service Provider Agreement (Specialist)
- Family Care Safety Registry
- Lobbying, Debarment, Suspension Form
- Medicaid/Medicare Provider Information
- Certification for Online Claims
- Electronic Signature
- User Online Access Request Form
- W-9
- EFT/Direct Deposit Authorization
- Complete a Fingerprint/Background Check
Applicant’s Privacy Rights - Review this document prior to registration.
MACHS Fingerprint Portal Registration - Schedule an appointment. The four digit registration number for First Steps applicants is 2298.
FAQ for Fingerprinting/Background Check Procedures
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:
- Service Provider Enrollment Checklist
- Service Provider Information Form
- Service Provider Agreement (Supervision Required)
- Family Care Safety Registry
- Lobbying, Debarment, Suspension Form
- Medicaid/Medicare Provider Information
- Certification for Online Claims
- Electronic Signature
- User Online Access Request Form
- W-9
- EFT/Direct Deposit Authorization
- Complete a Fingerprint/Background Check
- Applicant’s Privacy Rights - Review this document prior to registration.
- MACHS Fingerprint Portal Registration - Schedule an appointment. The four digit registration number for First Steps applicants is 2298.
- FAQ for Fingerprinting/Background Check Procedures
Parents/Family Members
All required forms for new family members who enroll in Missouri First Steps to provide transportation are listed below:
- Family Member Transportation Enrollment Checklist
- Family Member Transportation Enrollment Form
- W-9
- Transportation Billing Form - Blank
- Transportation Billing Form - Instructions and Completed Example
