MMAC New Providers
Welcome to the Missouri Medicaid Audit and Compliance (MMAC) New Providers section, your essential gateway to becoming an enrolled provider in Missouri’s healthcare system. As the demand for quality healthcare services continues to grow, navigating the enrollment process is crucial for both new and existing providers.
This comprehensive guide outlines the necessary applications and forms to ensure a smooth onboarding experience. Additionally, STL Fingerprinting in St. Louis is here to assist you with vital fingerprinting services, reinforcing our shared commitment to delivering safe, reliable, and high-quality care to the communities we serve. Let’s embark on this journey together!
Provider Enrollment Applications and Forms
Key Forms for Enrollment
- Organization MCO Network Provider Application
- Individual MCO Network Provider Application
- Ordering, Prescribing, and Referring (OPR) Provider Application
- PACE Provider Application – Individual
- PACE Provider Application – Organization
- Private Duty Nursing Addendum
- Provider Update Request
- Voluntary Termination Request Form
- Business Organizational Structure Form
- Electronic Funds Transfer (EFT) – Paper
- Attestation of Medical Records Loss or Destruction
- APRN – CPA Attestation
- Assistant Physician CPA Attestation
- Primary Care Physicians Rate Certification-Attestation
- Invasive Ventilator Addendum
- Hospice Nursing Facility Contacts Form
- Authorization by Clinic/Members Form
How STL Fingerprinting Can Assist You
ORI Number for Provider Enrollment
When completing your fingerprinting process, you will need the correct ORI (Originating Agency Identifier) number for MMAC. This unique identifier ensures that your fingerprinting results are directed to the right agency for processing.
MMAC
ORI: MO920251Z
Contact Us
Ready to start your provider application? Click here to begin the application process!
