TX HHS Form 5007. CMBHS Access Request and User Agreement

The TX HHS Form 5007, CMBHS Access Request and User Agreement, is a crucial document for Medicaid MH providers contracted by a Medicaid managed care organization. This form helps solve the problem of requesting access to the Clinical Management for Behavioral Health Services (CMBHS) system and agreeing to its terms.

This form requires essential information from the provider, including their legal name, street address, city, county, state, and ZIP code. Additionally, providers must provide one of the following identification numbers: Texas Identification Number (TIN), Social Security Number (SSN), Federal Employer Identification Number, or National Provider Identifier (NPI). The form also asks about the provider's business structure and whether they are certified as a Historically Underutilized Business.

The CMBHS system is used for collecting and monitoring client information and outcomes data. This form is typically used when a Medicaid MH provider needs to access the CMBHS system, which includes features such as the Adult Needs and Strengths Assessment (ANSA), Child and Adolescent Needs and Strengths (CANS), Client Profile, and Utilization Management (UM) Guidelines and Manual.