About Us
Information for Providers
Please see the below information for MHRBWCC policies, procedures, and forms for our provider agencies.
Please note that all forms are currently being updated to be fillable PDF forms and will be available it that format no later than 8/1/2024.
Intake Forms
Claims & Info System Notice of Enrollment
Reportable Incident Forms
Community Agency Reportable Incident Form
Residential Facility Reportable Incident Form
Special Request Forms
1-3 Pre-Authorization for Continued Service Beyond Limits
2-6 Residential Service Auth-MH Housing
2-6 Residential Service Auth-Recovery Housing
3-2 Youth Inpatient Hospitalization Request
3-4 Private Hospital Request for Transfer to Summit Behavioral Health Care