Authorization and Registration

Service Authorization Forms, Registration Forms, Authorization Forms and Peer Support Service Forms

Process for Submitting Service Authorizations for All Behavioral Health and ARTS Services

All service Authorizations are now handled by Acentra Health (formerly KePro), who will oversee all service authorizations for behavioral health for fee for service members. Please review the essential Medicaid Bulletins regarding the transition to Acentra Health, as well as information about provider training.

Service Authorization Forms

For ASAM Levels 2.1/2.5/3.1/3.3/3.5/3.7/4.0

Arts Initial Service Authorization Request Form
Arts Extension Service Authorization Request Form
Service Authorization Notification Process by Managed Care Health Plan and Acentra Health

Substance Use Case Management Registration Forms

ARTS and Mental Health Services Registration Form Effective February 21, 2024

Pharmacy Services Authorization Forms

DMAS Pharmacy Service Authorization Forms
Managed Care Organization Preferred Formulary Drugs Description
Buprenorphine Implant Service Authorization Form