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Prior Auth Form
Claim Adjustment/
Corrected Claim Form
EFT Form
Third Party Liability (TPL) Form
Provider Update Form/ Practice Change Form
PCP Change Form

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Frequently Asked Questions

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Provider Resources - Missouri  ( Forms are in Adobe Acrobat Reader.)

Announcements:

04-20-10: SCHEDULED MAINTENANCE: The CMFHP website will be down for maintenance beginning April 23rd at 3:00. It is scheduled to be operational beginning Monday morning April 26th by 8:00.
04-12-10: Providers can now submit "real-time" claims - see the online training manual (right sidebar) for more info.
04-12-10: New Prior Auth Quick Guide available

 
 
 

   
Claims Address Children's Mercy Family Health Partners
P.O. Box 411806, Kansas City, MO 64141-1806
Electronic Payer ID WebMD: 43173
Gateway EDI: 00173
SSI: 99999-0227
Companion Guide MO 837P        PDF      Word
Companion Guide MO 837I        PDF      Word

Medical Review Process

Medical review is conducted to confirm the medical necessity of treatments or services rendered, as well as the appropriateness of the care setting. Medical review requires evaluation of specific clinical information on-site, over the telephone, or via written communication. Medical Review Nurses compile all pertinent clinical information gathered from the treating practitioners/staff, review against the medical necessity decision criteria and consider individual patient needs. Once complete, the Medical Review Nurse confirms medical necessity, the appropriateness of the care setting, and authorizes the requested service. When the Medical Review Nurse is not able to confirm the medical necessity and appropriateness of care setting, the case is referred to a physician. The Medical Director makes the final decision.

Children’s Mercy Family Health Partners does not provide financial or other types of incentives to practitioners, employees, or other individuals that encourage decisions that result in underutilization.

If you would like to discuss a decision with Children’s Mercy Family Health Partners’ Medical Director, you may call the Prior Authorization Department at 1-888-691-4874 and ask to speak with the Medical Director.

Providers and/or members have the right to a copy of the criteria used in making decisions about requests. If you would like a copy of the criteria, please contact the Prior Authorization Department at 1-888-691-4874 or fax your request to 1-877-9366. Children’s Mercy Family Health Partners will mail or fax you a written copy of the criteria within three (3) business days of your request.

MO PHONE – 1-888-691-4872
KS PHONE - 1-888-691-4874




Forms Claim Adjustment Form/
Corrected Claim Form		 To request a correction or adjustment to a claim
  Beneficiary Bank Info For EFT
  Prior Authorization Form For services requiring a pre-auth
  Abortion Consent Form  
  Hysterectomy Consent Form  
  Pregnancy Risk Screening and Notification Form Please mail or fax (forwarding information noted on the form) to CMFHP to notify us of a pregnant member.
NOTE: The Appraisal for Pregnant Women Form may be used in lieu of the CMFHP form.
  (Sterilization) Consent Form MO HealthNet form
  MO HealthNet Support and Forms MO HealthNet state manuals home page - click on "forms"
  PCP Change Form
  Practice Change Form For providers who need to update address, contact information, NPI, personnel, etc.
Resources Provider Administration Manual
Companion Guide MO 837P         PDF      Word
Companion Guide MO 837I        PDF      Word
Behavioral Health - New Directions Behavioral Health
Prior Authorization Quick Guide
Case Management Quick Guide
Lead Quick Reference Guide  
SCHIP (MO HealthNet - formerly MC+) Frequently Asked Questions
Other Helpful Information Asthma Management Program CMFHP's comprehensive asthma health improvement program is available to eligible provider offices. CMFHP's Asthma Management Program earned the Leadership award from the U.S. Environmental Protection Agency.
  New Directions Behavioral Health home page New Directions Behavioral Health (NDBH) provider portal

NDBH Search by Provider Location

NDBH Search: Provider Name

  HeLP Program CMFHP's Healthy Lifestyles Program (HeLP) focuses on childhood obesity and related co-morbidities. This health improvement program is available to eligible provider offices.
  Lead Posioning Prevention Care Management CMFHP's Lead Posioning Prevention Care Management health improvement program is available for members with elevated blood lead levels. The care management program includes education and coordination of services and resources.
  Special Health Care Needs CMFHP Special Health Care Needs (SHCN) Outreach Coordinators work with Kansas Special Health Services Program (SHS) program staff to assist in providing care for members that are enrolled in the program.
  CMFHP Eligibility Information for patients interested in becoming members of Children's Mercy Family Health Partners.
Child Health Library Child health information from Children's Mercy Hospitals and Clinics: Care Cards, Well Child Cards, Healthy Kids University classes, podcasts, video and much more.
MO HealthNet (MHD) SCHIP/Medicaid Program for the state of Missouri. Home page for Missouri Department of Social Services - MO HealthNet Division
Missouri Medicaid Bulletins  
Missouri Medicaid Fee Schedule  
CMS Centers for Medicare and Medicaid Services
  Minority Vendors Minority Vendors - Children's Mercy Family Health Partners is interested in doing business with you. For more information please click on the following links: