- Behavioral health facility submission forms. Tip: Download the form and then fill it out to avoid browser discrepancies.
- Initial Request Form (PDF) (can be added to an Availity submission)
- Concurrent Request Form (PDF)
- Stepdown Request Form (PDF)
- Discharge Notification Form (PDF)
- Applied Behavioral Analysis (ABA) Initial Request Form (PDF)
- Applied Behavioral Analysis (ABA) Concurrent Request Form (PDF)
- Transcranial Magnetic Stimulation (rTMS) Request Form (PDF) for initial and ongoing services
For providers (change)