.jpg)
SMHK PRIOR AUTHORIZATIONS FORMS:
- SHOW ME HEALTHY KIDS _ Inpatient Prior-Authorization Form (PDF)
- SHOW ME HEALTHY KIDS _ Outpatient Prior-Authorization Form (PDF)
- Medicaid Exceptions Form (PDF)
- SMHK Outpatient Treatment Request Form (PDF)
- SMHK Medicaid Electroconvulsive Therapy (ECT) Form (PDF)
- SMHK Outpatient Psychological Testing Auth Request Form (PDF)
SMHK PRIOR AUTHORIZATION RESOURCES:
OUTPATIENT:
- SMHK Outpatient PA Info (PDF)
- SMHK TFC & Residential Member Incident Notification Form (PDF) (To report a hospitilization, detention, elopement, and/or overnight visit)
RESIDENTIAL:
- SMHK Residential PA Process (PDF)
- SMHK Residential Level of Care Criteria (PDF)
- SMHK - Residential Initial Authorization Template (PDF)
- SMHK - Residential RE-Authorization Template (PDF)
- SMHK - Residential Authorization Readiness Checklist (PDF)
TREATMENT FOSTER CARE (TFC):
- SMHK - TFC Initial Authorization Template (PDF)
- SMHK - TFC Re-Authorization Template (PDF)
- SMHK Treatment Foster Care Level of Care Criteria (PDF)
- SMHK Treatment Foster Care PA Process (PDF)