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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 Provides 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)
- SFY_2025_BH_Code_Charts_and_Provider_Qualifications (Excel File)
Provider Meetings
Contract Templates and Network Monitoring
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- Master Agreement for Provider Services FY24
- BABHA_ Statement of Work Ancillary Care – FY25
- Statement of Work CLS Behavior Aides
- BABHA Statement of Work CLS SIPs and in-home staffing – FY25
- BABHA_Statement of Work Group Resi Type B – FY25
- BABHA_Statement of Work Indiv Resi Type A – FY25
- Statement of Work Inpatient
- BABHA Statement of Work Indv. Practitioners – FY25
- BABHA Statement of Work Primary Care – FY25
- BABHA Statement of Work Crisis Residential FY25
- Statement of Work Vocational Services – FY24
- Exhibit D – Credentialing Recredentialing Requirements
- BABHA Statement of Work Specialty Services-Therapeutic Activities 6-2024
- BABHA Statement of Work IPS Supported Employment FY25
- MSHN Regional ABA Template FY25 FINAL
- MSHN Regional FMS Template FY25 – FINAL
- MSHN Regional Inpatient Contract FY25 – FINAL
- Exhibit B – PROVIDER DISCLOSURES-fillable
Site Review Templates
- ABA Regional Organization-Wide Core Standards Tool
- ABA Regional RR Site Specific Tool
- Community Living Supports Tool
- Primary Provider Tool
- Specialized Residential Tool
- Vocational Tool
Organizational Credentialing Policy and Procedure – See Policies and Procedures page for most current version of C08-S06-T06
2024 BABH Service Risk Assessment Scoring Worksheet
Provider Training
Contractual Training Requirements
- ABA Techs Required Training
- Ancillary Care Required Training
- Autism Professionals Required Training
- CLS In Home Required Training
- CLS SIPs Required Training
- Clubhouse Drop-In Peer Supports Required Training
- FY25 MSHN Training Grid and Definitions
- Ind Facilitators Required Training
- Primary Care 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 2024 FINAL
- CLS-Voc Billing of Transportation Matrix – Updated 2024 FINAL
- 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
- Recipient Rights Poster
- Spanish Recipient Rights Poster
- RR STAFF TRAINING
- Whistleblower Protection Act Poster 2014
Medicaid Bulletins and Letters (i.e., updates to Medicaid Manual)
Practice Guidelines
Behavioral Health TEDS
Forms for Providers
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- 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 2019 – 12pt