№ files_lp_4_process_3_133622
Administrative healthcare authorization and referral form used within the Medi-Cal specialty mental health system to request and document approval of Therapeutic Behavioral Services for eligible youth receiving services from a Specialty Mental Health Provider.
Document Type: Prior Authorization Request and Referral Form
Program: Therapeutic Behavioral Services (TBS)
Service System: Specialty Mental Health Services (SMHS)
Related Program: Medi-Cal
Institution / Organization: Optum
Submitting Entity: Specialty Mental Health Provider (SMHP) or TBS Provider
Target Population: Youth under age 21 receiving Medi-Cal funded specialty mental health services
Eligibility Reference: DMH Information Notice No. 08-38
Medical Necessity Standard: BHIN 21-073
Associated Services: Behavioral Health Assessment (BHA), Outpatient Authorization Request (OAR)
Authorization Period: Up to 6 months of TBS intervention
Maximum Weekly Service Level: Up to 25 hours of TBS intervention per week
Service Components: Assessment (SC48), Plan Development (SC46), Intervention (SC47), Collateral (SC49)
Reviewing Authority: Optum Clinician
Decision Outcomes: Authorized, Modified, Reduced, Denied, Suspended, or Terminated
Beneficiary Program: Medi-Cal Full-Scope Beneficiary
Submission Context: Request for authorization of behavioral intervention services for eligible youth receiving specialty mental health treatment
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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