Service Authorization Checklists

Check It - checkmark in checkbox

Want to avoid hold-ups caused by missing information in Srv Auth requests? Check out our Service Authorization Checklists. These handy reference lists will help you determine at a glance all the information required for each service type. Don't be stuck retrieving information twice! Use the checklists for once-and-done submission!

Please limit the use of special characters in your answers and review your information after you enter it to be sure it is correct.

To view a document and then save it:
Click on the link in the document list to view the document in your browser. From the menu at the top of the browser, select FILE - SAVE AS to navigate to the folder in which you wish to save the document. Then save it.
To save the document without opening it:
Right-click the link in the document list and select "Save target as". Navigate to the folder in which you wish to save the document. Then save it.

TitleDescriptionFile SizeFile Type
Group Home A-B Continued Checklist(Revised 10/31/2011)28 KB.doc
Group Home A-B Initial Checklist(Revised 10/31/2011)30 KB.doc
Outpatient Psych Continued(Revised 10/31/2012)32 KB.doc
Outpatient Psych Initial Request(Revised 10/31/2011)30 KB.doc
Residential Treatment Care level -C InitialOOS requirements updated 2/14/1328 KB.docx
Residential Treatment Care level- C continued stay ChecklistOOS requirements updated 2/14/1327 KB.docx
TFC-CM Continued Stay Checklist(Revised 10/31/2011)50 KB.doc
TFC-CM Initial Checklist 60 KB.doc

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