About Us
Information for Providers
Please see the below information for MHRBWCC policies, procedures, and forms for our provider agencies.
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