![]()
Behavioral Health Information
- Behavioral Health Services Tier System
- Behavioral Health Pre-Authorization/Notification Form
- Behavioral Health Additional Case Management Units Form
- Behavioral Health Additional Services Form
- Behavioral Health Discharge Information Form
- Behavioral Health Inpatient Continued Stay Form
- Behavioral Health Medical Necessity Criteria
Medical Information
(Medicare as primary payor and FCA as secondary payor authorization not required).
- Diagnostic Code List for Additional Prenatal Services
- DME Pre-Authorization Pricing Form
- Inpatient Authorization Process
- Medicaid Pharmacy Pre-Authorization Form
- Medical Pre-Authorization Form
- Non-Par Provider Registration Form
- Pre-Authorization List