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Psychological or Neuropsychological Testing Request Form This is a request to review if the treatment meets the medical necessity definition under the members' health plan. It does not confirm the
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Who needs psychological or neuropsychological?

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Individuals experiencing mental health issues
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Psychological or neuropsychological refers to assessments or evaluations of an individual's mental health or cognitive functioning.
Certain individuals such as healthcare professionals, psychologists, or neuropsychologists may be required to conduct and file psychological or neuropsychological assessments.
Psychological or neuropsychological assessments are typically filled out by trained professionals using standardized tests, questionnaires, and clinical interviews.
The purpose of psychological or neuropsychological assessments is to evaluate an individual's mental health, cognitive abilities, and identify any potential areas of concern or impairment.
Information reported on psychological or neuropsychological assessments may include test scores, clinical observations, and diagnostic impressions.
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