Get Spending Request Form

Filling out the Spending Request Form online is an essential process for securing necessary funding. This guide provides clear instructions and insights into each section of the form to ensure a smooth submission experience.

Follow the steps to accurately complete your Spending Request Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the date of your request. Fill in the requested by section with your full name, organization, and department details. Additionally, enter your contact phone number.
3. In the Reviewed by and Approved by sections, leave spaces for internal reviewers to sign or acknowledge receipt of the form.
4. Record the funding date once it has been determined. This field may be left blank initially.
5. Enter the member's name, date of birth, and Health Plan ID if applicable. This information is crucial for identification purposes.
6. In the Diagnosis with ICD 9/DSM Code section, include the funded diagnosis relevant to the request. Make sure to check accuracy as this information is vital for processing.
7. Specify the amount you are requesting in the Amount Requested field. Be as detailed as possible.
8. Clearly indicate what is being requested in the What is being requested section and describe the purpose of the request.
9. Outline the expected outcome in measurable terms. This will help reviewers understand the anticipated benefits of the funding.
10. Provide any additional information that may support your request. Make sure to check that all supporting documentation is included.
11. After completing the form, you can save changes, download, print, or share the form as needed.

Complete your Spending Request Form online today to ensure your funding request is processed efficiently.