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Add/Remove Phoenix Users PDF form to save and send in via email
For Existing Providers
Become a Provider
- Provider Network Application
- Organizational Credentialing Policy and Procedure
- BABH Service Provider Risk Assessment
- New Contract Check List
Provider Billing
- Link to Phoenix login
- ACH Form for Providers and Vendors
- Adjustment and Void Request Form
- Bay-Arenac 5010A1 Professional Claims Companion Guide (Revised 20240322)
- Bureau of Specialty Behavioral Health Services Telemedicine Database (12/20/2023)
- Phoenix claims submission instructions
- PHOENIX Provider Claims Submission
- Provider Claims Flow
- Provider DDE Instructions
- Policy and Procedure – Claims Auditing – Adjustments, Dispute Resolutions and Appeals Processes
- Provider Service Dispute Resolution Form(June 2024)
- Rounding Rules for Behavioral Health Services after COVID-19 Crisis 3.15.23
- SFY_2024_Behavioral_Health_Code_Charts_and_Provider_Qualifications (excel file)
- 2023 MHCodeChart
- Provider Meetings
- Master Meeting Schedule
- Specialized Residential Provider Meetings
- Primary Care Provider Meetings
Contract Templates and Network Monitoring
Contract Templates
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- Master Agreement for Provider Services FY24
- Statement of Work Ancillary Services FY24
- Statement of Work ABA Providers
- Statement of Work CLS Behavior Aides
- Statement of Work CLS and in-home staffing FY24
- Statement of Work Group Resi Type B -FY24
- Statement of Work – Indiv Resi Type A -FY24
- Statement of Work Inpatient
- Statement of Work Indv. Practitioners – FY24
- Statement of Work Peer Support Services
- Statement of Work Primary Care – FY24
- BABHA_SoW_Crisis Residential FINAL
- Statement of Work Vocational Services – FY24
- Exhibit D – Credentialing Recredentialing Requirements
Site Review Templates
- Organizational Credentialing Policy and Procedure – See Policies and Procedures- C08-S06-T06
- 2022 BABH Serv Prov Perf Risk Assess Scoring Worksheet
Provider Training
Contractual Training Requirements
- ABA Techs Required Training
- Ancillary Care Required Training
- Autism Professionals Required Training
- CLS_Beh Aides Required Training
- CLS-In Home Required Training
- CLS_SIPs-Required-Training
- Clubhouse – Drop-In Peer Supports Professional Required Training
- Ind Facilitators Training Requirements
- FY24 MSHN Training Grid
- Primary Care Required Training
- Self-Determination Required Training
- Specialized Residential Required Training
- Vocational Providers Required Training
- Web-based Training Resource
This link will redirect you to the BABHA Web-Based Training Resource site. This site requires a username and password. New users may contact the BABH Staff Development Center at StaffDevelopment@babha.org or (989) 895-2395 to request a username and password.
Other Reference and Educational Materials/Forms
- BABHA Nondiscrimination Notice Statement for posting 2017
- BABH Summary of Medicaid Provider Qualifications
- BABH Training on Provider Qualifications_Dec2019
- CASE FILE CONFIDENTIAL STATEMENT
- CLS-Voc Billing of Lunches Matrix – Updated 2019-05-28
- CLS-Voc Billing of Transportation Matrix 2019-08-22
- CMH Site Visit Form – Guidance
- CMH Site Visit Form
- Complaint Form Updated 2020
- Deferment Education Letter 12-20-2022
- Home and Community-Based Services (HCBS) Program Transition
- Hours of Operation for BABH and its Primary Care Contractors 3-17
- MDHHS BHDDA Credentialing Requirements
- Medicaid Provider Manual
- Mental Health Code Ch 7 & 7a
- PIHP/CMHSP Encounter Reporting Costing Per Code and Code Chart
- PIHP/CMHSP Provider Qualifications Chart
- Record Keeping Reminder
- RR Poster revised 11-2020
- Spanish RR Poster revised 10-29-2021
- RR STAFF TRAINING 2020
- Taglines 2019 – 12pt
- Whistleblower Protection Act Poster 2014
Medicaid Bulletins and Letters (i.e., updates to Medicaid Manual)
Practice Guidelines
Behavioral Health TEDS
Forms for Providers
- AUTHORIZATION TO DISCLOSE – Multicounty
- AUTHORIZATION TO DISCLOSE
- BABHA Nondiscrimination Notice Statement for posting 2018 – 12pt
- DCH-0044E_Incident_Report__487741_7
- Incident Report BCAL 2016
- Incident Report Guidelines-Expectations
- Supplemental Form for the Behavior Intervention IR 9-22-23
- Taglines 2018 – 12pt
Information Regarding COVID-19 for Providers
- New Federal COVID Website
- BH Provider Letter
- Rounding Rules for Behavioral Health Services after COVID-19 Crisis 3.15.23
- UPDATED MDHHS Residential Care Epidemic Order– Updated 2.21, 12.8.20, 10.28.20; Released 10.6.20
- https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html
- BH Communication Infection Control Guidance 20-12
- MDHHS Testing Cadence Guidelines _ C
- MDHHS Testing Priority Strategy Grid
- MDHHS MSA 20-56
- Provider Stabilization Plan-MSHN
- Recovery from COVID-19 Preparedness and Response Plan 06-05-2020
- Staff Screening Tool
- Consumer ON site screening tool
- Consumer Screening Tool OFF site
- https://www.cdc.gov/coronavirus/2019-ncov/index.html
- https://www.bridgemi.com/tags/coronavirus-michigan
- https://www.michigan.gov/documents/whitmer/MI_SAFE_START_PLAN_689875_7.pdf
- https://www.mistartmap.info/