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 Form Resource Center for Behavioral Health Clinicians Choose a Category Please do not use the outpatient forms on this website for ABA therapy requests. Contact the Autism team for forms and information. Facility-Based Treatment Use this form to request certification 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 certification 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 certification 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 certification 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 certification for all SC Department of Mental Health outpatient services. Privacy Legal Sitemap © 2023 Companion Benefit Alternatives, Inc. All rights...