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MEDICARE BEHAVIORAL HEALTH AUTHORIZATION FORM Fax requests to (866) 2562015. For questions call (800) 4929634. To find forms on our website visit http://pedicare.peds.ufl.edu. Section 1: Member Info

How to fill out ped-i-care behavioral health authorization

How to fill out ped-i-care behavioral health authorization:

1. Start by obtaining the appropriate form: The ped-i-care behavioral health authorization form can typically be found on the official website of the organization or agency providing the services. Alternatively, you can reach out to a representative of ped-i-care for assistance in obtaining the form.
2. Carefully read the instructions: Familiarize yourself with the instructions provided on the form. Pay attention to any specific requirements, guidelines, or documents that need to be attached or completed alongside the authorization form.
3. Provide your personal information: Begin by filling out your personal details accurately. This may include your full name, date of birth, contact information, and any identification numbers or codes that are requested.
4. Specify the services required: Indicate the specific behavioral health services you are seeking authorization for. This may include therapy sessions, psychiatric evaluations, medication management, or other types of treatments. Be as detailed and specific as possible to ensure accurate authorization.
5. Include the provider's information: Provide the name, contact details, and any other required information of the healthcare provider or facility that will be delivering the services. This could be a therapist, psychiatrist, clinic, or hospital. It's essential to ensure the information provided is accurate and up to date.
6. Attach supporting documents: If there are any additional documents or reports required to support your request for behavioral health services, ensure they are attached. This may include previous medical records, test results, diagnoses, or letters of recommendation from healthcare professionals.
7. Review and sign the form: Carefully review all the information you have provided on the form before signing it. Ensure all the necessary fields are complete, accurate, and legible. If any mistakes or omissions are noticed, make the necessary corrections.
8. Submit the form: Once the form is complete and signed, submit it to the appropriate department or individual as instructed on the form itself. Pay attention to any specific submission guidelines or deadlines to avoid any delays in the authorization process.

Who needs ped-i-care behavioral health authorization?

1. Individuals seeking behavioral health services: Any individual who wishes to access behavioral health services covered by ped-i-care will be required to obtain the ped-i-care behavioral health authorization. This includes both children and adults.
2. Healthcare providers: Healthcare providers or facilities that offer behavioral health services and wish to be reimbursed by ped-i-care will need to ensure that they receive proper authorization from the patient or the patient's representative. This authorization will serve as a confirmation that the services are medically necessary and eligible for coverage.
3. Parents or legal guardians: In the case of minors or individuals who are unable to provide consent themselves, parents or legal guardians will need to complete the ped-i-care behavioral health authorization on behalf of the patient. This ensures that the necessary approvals and authorizations are in place for the child or dependent to receive the required behavioral health services.

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What is ped-i-care behavioral health authorization?

Ped-i-care behavioral health authorization is a form required for providers to request authorization for behavioral health services for Medicaid beneficiaries under the age of 21.

Who is required to file ped-i-care behavioral health authorization?

Providers who wish to provide behavioral health services to Medicaid beneficiaries under the age of 21 are required to file ped-i-care behavioral health authorization.

How to fill out ped-i-care behavioral health authorization?

Providers must complete the form with all required information, including details about the beneficiary, the requested services, and supporting documentation.

What is the purpose of ped-i-care behavioral health authorization?

The purpose of ped-i-care behavioral health authorization is to ensure that Medicaid beneficiaries under the age of 21 receive medically necessary behavioral health services.

What information must be reported on ped-i-care behavioral health authorization?

Providers must report information about the beneficiary, the requested services, and any supporting documentation required for authorization.