Common Forms

Behavioral Health Treatment - Access to Care Form  Submit completed form within 30 days of the start date of the FBA authorization.

Behavioral Health–Authorization Request Form (BH-ARF)  Submit along with clinical documentation to request a review to authorize behavioral health services. For Applied Behavior Analysis (ABA), please use the BHT-ARF form.

Behavioral Health Treatment-Authorization Request Form (BHT-ARF)  Submit along with clinical documentation to request a review to authorize BHT/ABA service.

Psychological Testing Pre-Authorization Request Form  You must submit this form to pre-authorize all psychological testing