Provider Guide

Provider Guide & Forms

The Provider Guide explains our authorization process and will answer many questions you may have. You can also browse and download our provider forms here.

Psychiatrists, Physician’s Assistants and Nurse Practitioners

Clinical Assessment Report and Treatment Plan: Medication Evaluation/Management
ECT Preauthorization Request
TMS Preauthorization Request
Progress Report
Additional Notes (Optional)
Supervisory Referral Assessment Report
Esketamine Treatment Request

Psychologists and Master’s-level Professionals

Clinical Assessment Report and Treatment Plan
Progress Report
Psychological Testing Preauthorization Request Form
Additional Notes (Optional)
Supervisory Referral Assessment Report

Provider Guide & Forms

Psychiatrists, Physician’s Assistants and Nurse Practitioners

Psychologists and Master’s-level Professionals

Other Documents