Get Cc Psr Service Authorization

Filling out the CC PSR Service Authorization is an important step in securing necessary psychosocial services. This guide will provide clear, step-by-step instructions to help users accurately complete the form online, ensuring all necessary information is included for review.

Follow the steps to complete the CC PSR Service Authorization online.

1. Click ‘Get Form’ button to obtain the CC PSR Service Authorization form and open it in the editor.
2. Begin by selecting the Management Care Organization (MCO) by checking the appropriate box for Anthem, Beacon/Humana, or Virginia Premier.
3. Fill in the individual’s name along with their date of birth, initial assessment date, and admission date to psychosocial services.
4. Provide the assessor’s name and phone number to ensure accurate communication.
5. Input the Medicaid number and answer whether a retroactive review is needed by checking ‘Yes’ or ‘No’.
6. Indicate the requested dates for approval of psychosocial services along with the total number of units requested.
7. Complete the diagnostic information by filling out the Axis I, II, III, IV, and V fields.
8. List all known medical conditions and current medications, including the name, dosage, frequency, and prescriber’s name.
9. If there are past medication compliance issues, indicate ‘Yes’ or ‘No’ for each issue.
10. In Section II, denote whether the individual has an Integrated Care Plan, to determine the next steps.
11. If applicable, proceed to Section IV; if not, complete Section III by checking the psychosocial eligibility criteria that apply.
12. Describe any current symptoms or behaviors that support the checked criteria, noting their frequency, intensity, and duration.
13. List mental health treatment goals in Section IV, including progress and lack of progress for each goal.
14. Indicate the individual’s primary care provider (PCP) status and whether there has been communication regarding treatment coordination.
15. Finalize by obtaining signatures from the qualified mental health professional (QMHP) and the licensed mental health professional (LMHP) along with the date.
16. Finally, ensure to fax the completed form to the appropriate MCO indicated in Section I using the listed fax numbers.

Complete your CC PSR Service Authorization online today to ensure timely access to psychosocial services.