Introduction
Find instructional guides and forms for all your levels of care and administrative needs by selecting ‘Guides’ and ‘Forms’ in the menu.
Guides
Please note: Billing manuals and guides live here.
Authorization Request Mapping Guide
Authorization Parameters (Submission Guidelines)
- Authorization Parameters – Requirement Grid, Turnaround Times, and Submission Timeframes
Authorization Spans and Codes
American Society of Addiction Medicine (ASAM) Smart Testing Guidelines
Master Service Authorization Grids (MSAG)
Levels of Care Appendix
EVS User Guide
Billing Appendix
UB04 Billing Instructions
ProviderConnect User Guide
Long Term Care – OES Process & Spans Reporting
DORS User Guide
Poverty Guidelines
Forms
1915(i) Referral Form
Claims Appeals Form
Bed Hold Form
3.1 Residential Administraive Day Request Form
Release of Information (ROI) and Referral Forms
Third-Party Liability Forms
Uninsured Exception Form
CMS 1500 Form
OES Forms
DHR/IMA 81 Form
Potential Quality of Care Form
Critical Incident Form
Second Guest Dosing Form