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 Quality Health Website for forms, education, training and contact information.

Home Support Services

Integrated Co-Occurring Treatment (ICT)

Mountain Pacific Quality Health Forms for Psychiatric Residential Treatment Facilities

Non-Medicaid Services Forms

Psychiatric Residential Treatment Facilities (PRTF/PRTF-AS)

Serious Emotional Disturbance (SED) Diagnosis

Therapeutic Group Home