Clinical
- Spravato Provider Authorization Form
- Spravato Pharmacy Prior Authorization Form
- ICC Referral Form
- Higher Level of Care Frequently Asked Questions
- Inpatient Registration Quick Reference Document
- PRTF Referral Form
- Solnit Hospital Referral Form
- Appointment of Authorized Representative
- Release of Information (English)
- Release of Information (Spanish)
- Authorization for Carelon Behavioral Health to Release Designated Record Set Information
Provider Relations
- Provider Data Verification Form (PDV) – Referral Updates
- Online Services Account Request Form – Writable
- Online Super User Account Request Form
- Behavioral Health Dual Coverage Frequently Asked Questions
- Carelon Behavioral Health Notice of Privacy Practices
