Get the free KanCare Psych Testing Request Form - Provider Express

Psychological and Neuropsychological Testing Request Form Please fax completed form to (855) 268-9392. Name of Member to Receive Testing: Member s DOB: Enrolled ID #: Testing Dates of Service Requested:

How to fill out kancare psych testing request

Who needs kancare psych testing request?

1. Individuals who are enrolled in the Kansas Medicaid program, known as KanCare, and are seeking psychological testing services may require a KanCare psych testing request form.
2. This form is applicable to individuals of all ages, including children, adults, and seniors, who are covered under the KanCare program and are specifically in need of psychological assessment or evaluation.
3. Those who believe they may benefit from psychological testing or require it as part of their ongoing healthcare treatment plan can discuss this with their primary care physician or mental health provider to determine if a KanCare psych testing request is necessary.

How to fill out a KanCare psych testing request form?

1. Begin by obtaining a copy of the KanCare psych testing request form. This form can typically be obtained from the KanCare website or by contacting the KanCare customer service hotline.
2. Fill in the personal information section of the form, including your full name, address, contact number, date of birth, and KanCare identification number. Make sure to provide accurate and up-to-date information to avoid any potential delays or complications.
3. Next, provide the name and contact information of your primary care physician or mental health provider who is recommending the psychological testing. This information is crucial for communication and coordination between healthcare providers and ensures that the necessary documentation is shared appropriately.
4. In the "Reason for Psych Testing" section, clearly explain the specific reasons or concerns that warrant the need for psychological evaluation. Be as detailed as possible, describing any symptoms, behaviors, or circumstances that led to the recommendation for testing.
5. If applicable, include any relevant medical history or previous psychological evaluations that may support the need for further testing. This information can help healthcare providers make informed decisions regarding the most appropriate course of action.
6. Sign and date the form to indicate your consent and understanding of the psych testing request. By signing the form, you authorize the release of relevant medical records and confirm your willingness to undergo psychological testing as recommended.
7. Finally, submit the completed psych testing request form to your primary care physician or mental health provider. They will review and sign the form before forwarding it to the appropriate KanCare representative for processing.

Note: It's important to follow any additional instructions provided by your healthcare provider or KanCare to ensure a smooth and efficient processing of your psych testing request.

For pdfFiller’s FAQs

What is kancare psych testing request?

Kancare psych testing request is a form that must be filled out to request psychological testing services under the Kancare program.

Who is required to file kancare psych testing request?

Healthcare providers, psychologists, or other qualified professionals are required to file the Kancare psych testing request.

How to fill out kancare psych testing request?

To fill out the Kancare psych testing request, the provider must include patient information, reason for testing, and any relevant medical history.

What is the purpose of kancare psych testing request?

The purpose of Kancare psych testing request is to assess and diagnose mental health conditions in Kancare beneficiaries.

What information must be reported on kancare psych testing request?

The Kancare psych testing request must include patient demographics, reason for testing, any prior treatment, and anticipated outcomes.

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