forms.companionbenefitalternatives.comCompanion Benefit Alternatives Form Resource Center

') Companion Benefit Alternatives, Inc. Form Resource Center Companion Benefit Alternatives Home Contact Us Home Welcome to the Companion Benefit Alternatives Form Resource Center for Behavioral Health Clinicians Choose a Category Facility-Based Treatment Use this form to request precertification for both mental health and substance use disorder treatment for inpatient, residential treatment (RTC), partial hospitalization (PHP), intensive outpatient (IOP) or outpatient electroconvulsive therapy services. Outpatient Medication Management Use this form to request precertification for outpatient medication management CPT codes. Do not use this form to request individual or group therapy. Only providers with prescriptive authority should use this form. Outpatient Mental Health Treatment Use these forms to request precertification for outpatient mental health treatment services (e.g. individual or group therapy). Do not use these forms for services related to substance use disorder (SUD), intensive outpatient programs (IOP) or partial hospitalization programs (PHP). Outpatient Substance Use Disorder Treatment Use this form to request precertification for outpatient substance use disorder (SUD) treatment services (e.g. individual or group therapy). Do not use this form for mental health treatment requests, intensive outpatient programs (IOP) or partial hospitalization programs (PHP). SC Department Of Mental Health Treatment Use these forms to request precertification for all SC Department of Mental Health outpatient services. Privacy Legal © 2011 Companion Benefit Alternatives, Inc. All rights reserved....