Children's Mental Health Provider Forms

Effective January 1, 2020, in partnership with Telligen, Mountain-Pacific will provide the utilization and review of behavioral health services provided by Children's Mental Health.  Please check out the Mountain Pacific Website for forms, education, training and contact information.

Appeal Forms

Acute Hospital

Home Support Services

Integrated Co-Occurring Treatment (ICT)

Mountain Pacific Quality Health Forms for Psychiatric Residential Treatment Facilities

Non-Medicaid Services Forms

Partial Hospital Program

Psychiatric Residential Treatment Facilities (PRTF/PRTF-AS)

Serious Emotional Disturbance (SED) Diagnosis

Therapeutic Group Home

Youth Genetics Testing for Mental Health