Get Cmbhs

Filling out the Clinical Management for Behavioral Health Services (CMBHS) access request and user agreement form is an essential step for organizations seeking to engage with the behavioral health services in Texas. This guide provides clear instructions for completing the form effectively.

Follow the steps to complete your Cmbhs access request and user agreement form.

1. Press the ‘Get Form’ button to retrieve the document and open it in your chosen online form editor.
2. Enter the legal name of your organization as stated in your documentation from the IRS, Comptroller, or Secretary of State.
3. Provide your full address, including the street and mailing addresses, city, county, state, and your 9-digit zip code.
4. Select and enter one of the following identification numbers: Texas Identification Number (TIN), Federal Employer Identification Number (FEIN), or Social Security Number (SSN).
5. Indicate your legal status by selecting the appropriate option provided in the form.
6. Specify your type of business structure and, if applicable, provide additional information if 'Other' is selected. If your organization is a partnership, include the SSN or TIN for at least two partners.
7. Answer whether your entity is certified as a Historically Underutilized Business by selecting the appropriate option.
8. Fill in the point of contact information, including the name, title, email, and phone number of the designated representative.
9. List which Managed Care Organization(s) your organization has an agreement with.
10. Review all entries for accuracy and completeness before proceeding with your submission.
11. Once all information is correct, you can save your changes, download the document, print it, or share it as required.

Start your application and complete the necessary documents online today!