Managed Care Providers

Forms
Medication Prior Authorization Request Form
New Directions Outpatient Treatment Request Form
Certification of Treating Health Care Provider for Expedited External Review
Therapist Initial Assessment Form
Substance Abuse Outpatient Treatment Request Form
Mental Status Examination Form
Provider Facility Update Form
Blue Cross and Blue Shield of Kansas Inpatient/PHP/IOP Treatment Request Form
Provider Survey Form
External Review Request Form
Request for Psychological Testing
Medication Log Form
Request Psychological Testing Form for BCBS of Kansas
Patient Information Form
Florida Provider Survey Form