Requesting Authorization

Authorization should be obtained prior to services being rendered and for continued services.

This Provisional Plan of Care and Freedom of Choice Form is used for all youths enrolling in CSoC when an authorization is being made at the time of enrollment.

• This Provisional Plan of Care Form is also available in Spanish and Vietnamese.

This Provisional Plan of Care and Freedom of Choice Form is used when adding a service, along with the Plan of Care, after enrollment.

• This Provisional Plan of Care and Freedom of Choice Form is also available in Spanish and Vietnamese.

Regular Routine Outpatient Therapy, Medication Management, and Psychological Testing will not require an authorization until the fifty-two (52) pass through service limits have been utilized.

All authorization requests for outpatient services must be included in the member's plan of care.

Additionally, crisis services can be requested by telephone at 1-800-424-4489 when the crisis occurs.

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