PLEASE NOTE: For State Health Plan members, use the commercial fax forms.
Behavioral Health Fax Forms:
- Adaptive Behavioral Treatment for Autism Spectrum Disorder/Applied Behavioral Analysis (ABA/ABT)
- Behavioral Health Care Length of Stay Extension
- Eating Disorder (Inpatient or Residential Treatment)
- Electroconvulsive Therapy (ECT)
- Inpatient Psychiatric Care
- Residential Treatment for Behavioral Health
- Residential Treatment for Substance Use Disorder
- Transcranial Magnetic Stimulation (TMS)