Provider Information and Forms
Thank you for participating in Magellan Medicaid Administration behavioral health program in Montana. Below you will find links to resources such as manuals and forms.
Severe disabling mental illness (SDMI) affects adults aged 18 or more years. Find the criteria for SDMI beginning on page six in the AMDD Provider Manual below.
Serious emotional disturbance (SED) affects youth from age 6 through 17. Find the criteria for SED beginning on page 12 in the CMHB Provider Manual below.
Adult Acute Inpatient Provider Manual (Rev. 3/19/19)
Youth In-state PRTF Denial Letter (Rev. 1/18/19)
Youth Discharge Notification Form (Rev. 1/18/19)
Youth Data Corrections Request Form (Rev. 1/18/19)
Youth PRTF Continued Stay Request Authorization Form (Rev. 1/18/19)
Youth PRTF Certificate of Need (Rev. 1/18/19)
Youth Admin Review Request Form (Rev. 1/18/19)
Youth Admin Fair Hearing Request Form – Claimant (Rev. 1/18/19)
Youth PA Request Form PRTF (Rev. 1/18/19)