Get Bcn Behavioral Health Continuing Otr Form - E-referral

Completing the BCN Behavioral Health Continuing OTR Form - E-Referral online is essential for ensuring that members receive the appropriate care and authorization for behavioral health services. This guide aims to provide clear and supportive instructions on each section and field of the form to help users navigate the process confidently.

Follow the steps to accurately complete the BCN Behavioral Health Continuing OTR Form - E-Referral online.

1. Press the ‘Get Form’ button to access the form and open it in the editing interface.
2. Begin filling in the member’s information, including their name, member number, and date of birth. Ensure that all personal identifiers are accurate and updated.
3. Provide details about the treating clinician including their type (MD/DO, licensed psychologist, etc.) and their name. If applicable, include the name of the supervising provider.
4. Select the type of authorization sought for the member: individual or organization, and provide associated NPIs if needed. Include the member’s treatment history by approximating the time spent in treatment.
5. Detail the current therapy modality. Options may include CBT, DBT, or other forms of therapy. Additionally, report on the current frequency of therapy sessions and the duration of the treatment episode.
6. Document the current DSM-5 diagnosis, related medical concerns, and any psychosocial factors impacting treatment. Current symptoms and functional impairments should also be listed in detail.
7. Report on the current psychiatric medication management by listing prescriber’s details, frequency of visits, and any medications taken. Confirm adherence to medication guidelines and any changes since the last review.
8. Outline the goals of treatment and the expected outcomes. Include measures for tracking progress toward those goals.
9. Answer the questions regarding treatment adherence clearly, noting any instances where the member may have struggled to follow recommendations.
10. Indicate the anticipated termination of treatment, specifying the targeted discharge date and the number of additional sessions requested.
11. Finally, ensure that the provider signs and dates the form, entering their NPI and tax ID number. Review the form for accuracy before submission.
12. Once completed, fax the form to 1-866-364-7145. Users can then save changes, download, or print the form for their records.

Complete your BCN Behavioral Health Continuing OTR Form - E-Referral online today to ensure timely access to necessary care.