Get Behavioral Health Services Mental Health Reauthorization Request Mental Health Reauthorization

The Behavioral Health Services Mental Health Reauthorization Request is an essential form for continuing mental health treatment. This guide provides clear instructions on how to complete the form online, ensuring that all necessary information is accurately provided for reauthorization.

Follow the steps to complete the reauthorization request accurately.

1. Click ‘Get Form’ button to obtain the Behavioral Health Services Mental Health Reauthorization Request form and open it for editing.
2. Begin by filling in the provider's information, including the provider's name, today's date, and agency details.
3. Input the consumer's information, such as their name, phone number, consumer number, date of birth, and fax number.
4. Indicate the date the current episode of care began.
5. Answer questions regarding suicidal or homicidal ideation, including current and past plans or attempts.
6. Indicate whether the patient has an alcohol or substance use problem and if they have been referred for treatment.
7. Describe the functional impairments experienced by the patient based on the impact of symptoms.
8. Provide information on any psychotropic medications the patient is taking, including the name of the prescribing professional.
9. Outline the planned frequency of visits for therapy.
10. Request additional sessions by specifying the number and type of CPT codes needed for the next 12 months.
11. Detail the primary and secondary diagnoses, outlining symptoms and treatment goals.
12. Conclude with the person completing the form’s name and title, and ensure to sign where necessary.
13. Once completed, save changes, download the form, and print or share as needed.

Complete your Behavioral Health Services Mental Health Reauthorization Request online today for timely reauthorization.