Get Request For Psychological Testing Precertification

The Request For Psychological Testing Precertification is an essential form that must be completed to obtain authorization for psychological testing. This guide provides clear, step-by-step instructions on how to fill out this form accurately and efficiently online.

Follow the steps to fill out the Request For Psychological Testing Precertification form online.

1. Begin by pressing the ‘Get Form’ button to acquire the form. This will bring the document up in your online editor.
2. Enter today's date at the top of the form. This helps track when the request is made.
3. Fill in the member's name, member ID number, and date of birth. Ensure this information is accurate to avoid delays.
4. Identify the person or agency making the request for testing by checking the appropriate box (e.g., PCP, psychotherapist, parent). If applicable, specify the medical specialty.
5. Provide the referring provider's information, including name, degree, address, phone number, and fax number.
6. Next, fill in the testing provider information in the same manner.
7. In the current or provisional DSM-IV section, enter the codes and descriptions for any diagnoses relevant to the member.
8. Answer the referral questions regarding the purpose of the testing and the current symptoms related to the referral question. Be clear and detailed.
9. Indicate how the results of the testing will influence the treatment plan and what additional information the testing will provide.
10. Complete the medical/psychological evaluation section by answering whether the client has had a diagnostic interview or previous psychological testing.
11. List any prescribed psychotropic medications, including specifics about the type of medication and if applicable, the date of the diagnostic interview.
12. Address the current substance use question by indicating whether the member is actively abusing any substances and provide details if necessary.
13. Select the requested testing by filling in the CPT code and listing the names and types of tests to be administered.
14. Finally, review your completed form for accuracy, and then save changes. You can choose to download, print, or share the form as needed.

Complete your Request For Psychological Testing Precertification online today for a smooth and efficient process.