See below for how to apply to complete the state Medicaid Provider Application, and please read the additional notes!
Please note: After you get your MMAC approval, you must apply for contracts with EACH managed care organization.
Steps for Applying to MMAC
- Must be 18 years old
- Hold a current birth doula certificate
- Obtain your NPI Number
- Purchase liability insurance
- Fill out MMAC application (see notes)
- Print MMAC application
- Sign MMAC Application
- Complete the BOS form, print, and sign
- Fax MMAC application to 573-634-3105 (see notes)
Notes
- Under Provider Type, select “41 – Doulas”
- Fill out ALL fields on every screen
- Check tabs at top of application, as there are multiple forms to fill out.
- Application
- Disclosures
- Electronic Funds Transfer Authorization Agreement
- Title XIX Participation Agreement
- Make sure all sections are printed and signed
- Include ALL of the following in your fax:
- All pages from the MMAC application
- BOS Form
- Copy of liability insurance
- Doula Certificate (and MDA certificate, if required)
- Voided check
- Social Security card or EIN letter (if using SSN card, make a high-resolution color copy first, and send THAT in the fax)
- Here is one option for affordable liability insurance for doulas: CM&F Group.
- You MUST submit this via actual fax. Do not try to use an “online fax” option.
- See our other guides:
Healthy Blue • Homestate Health • United Healthcare