SMHK PRIOR AUTHORIZATIONS

• SHOW ME HEALTHY KIDS _ Inpatient Prior-Authorization Form (PDF)
• SHOW ME HEALTHY KIDS _ Outpatient Prior-Authorization Form (PDF)
• Medicaid Out of Network and Exceptions Form (PDF)

• SMHK Outpatient Treatment Request Form (PDF)
• SMHK Medicaid Electroconvulsive Therapy (ECT) Form (PDF)
• SMHK Outpatient Psychological Testing Auth Request Form (PDF)

• SHOW ME HEALTHY KIDS Psychiatric Residential Treatment Facility Prior Authorization Process (PDF)

• SMHK Residential PA Process (PDF)
• SMHK Outpatient PA Info (PDF)
• SMHK  Residential Criteria Checklist (PDF)
• SMHK Treatment Foster Care Checklist (PDF)
• SMHK Treatment Foster Care PA Process (PDF)

• SMHK TFC & Residential Member Incident Notification Form (PDF) (To report a hospitilization, detention, elopement, and/or overnight visit)

RESIDENTIAL TEMPLATES

• SMHK - Residential Initial Authorization Template (PDF)
• SMHK - Residential RE-Authorization Template (PDF)

TREATMENT FOSTER CARE (TFC) TEMPLATES

• SMHK - TFC Initial Authorization Template (PDF)
• SMHK - TFC Re-Authorization Template (PDF)