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Managed Care Forms 


   This page is designed to help our clients, or any provider, quickly find the managed care  forms they need. We need your help with this page. We all know how quickly these companies seem to change their forms as well as where they need to be sent. If something on this list is outdated or incorrect please let us know so that we can quickly fix it. Also, if a form needs to be added please send it to us for consideration.   

American Behavioral Benefit Managers Behavioral Health Systems
  ABBM - OTR   BHS - Clinical Progress Report
  ABBM - Testing Request   BHS - Clinical Assessment Report & Treatment Plan
  ABBM - Federal Blue Cross OTR   BHS - EAP Form
  ABBM - BC out of state verification worksheet   BHS - Testing Request
  ABBM - EAP - Invoice   BHS - Medication Management
  ABBM - EAP - Summary of Service  
Magellan Mental Health Network
  Magellan OTR   Mental Health Net OTR
  Magellan Testing Request
Tricare-Champus United Behavioral Health
  Tricare - Champus (Value) Standard OTR   UBH OTR
  Tricare - Champus (Value) Retro OTR   UBH Testing Request
  Tricare - Champus (Value) Testing Request   UBH Adult Wellness Assessment
  Tricare - Champus (Value) Letter of Referral for LPC   UBH Youth Wellness Assessment
  Tricare - Champus (Value) Non-Covered-Waiver  
  Tricare - Champus (Value) Active Duty Referral Form  
Value Options Anthem
  Value Options OTR   Anthem - OTR
  Value Options Testing Request   Anthem - Psych Testing Request
  Value Options Med Management Registration

Please click here and e-mail us to update this list