Get Tcm Authorization Form - Provider Express

The TCM Authorization Form - Provider Express is an essential document required for initiating targeted case management services. This guide offers clear, step-by-step instructions for accurately completing the form online, ensuring all necessary information is provided.

Follow the steps to effectively complete the TCM Authorization Form

1. Press the ‘Get Form’ button to access and open the TCM Authorization Form - Provider Express in your document editor.
2. Begin by entering the client's information. Fill in the client’s name, date of birth, and PMI number accurately to ensure correct identification.
3. Provide the client’s address and phone number in the designated fields. This information is vital for communication regarding the client’s case.
4. Input the TCM provider’s name and address. This identifies the provider responsible for the client's case management.
5. Enter the agency or county that the TCM provider is affiliated with, as this indicates the governing body overseeing the services.
6. Specify the authorization start date. This signifies when the targeted case management services are set to begin.
7. Record the client's current diagnosis using the DSM-5 classification. Accurate diagnosis helps tailor the case management approach.
8. Document the date of the client’s last annual wellness physical. If this is unknown, please reach out to the member to gather this information.
9. Indicate any known medical issues by checking the relevant boxes for conditions such as diabetes or heart disease, and provide additional details if necessary.
10. Assess if the client has unmet or complex medical needs by selecting 'Yes' or 'No.' If applicable, provide a thorough explanation of these needs in the space provided.
11. Determine if the TCM provider has the necessary resources to assist the client by selecting 'Yes' or 'No.'
12. Consider if the client would benefit from a call from a TCM Care Advocate. Check 'Yes' or 'No' as appropriate.
13. Record whether the client has been hospitalized in the last six months for medical or behavioral reasons by checking 'Yes' or 'No.' If 'Yes,' specify the reason for hospitalization.
14. Indicate if there has been a change in the client’s commitment status. Answer with 'Yes' or 'No' as applicable.
15. Complete the LOCUS/CASI assessment within 30 days of the TCM start date as required.
16. Once all fields are completed, save your changes, and utilize the options to download, print, or share the form as needed.

Ensure your TCM Authorization Form - Provider Express is filled out accurately and submit it online.