Authorization and Registration

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

Modern Process for Submitting Service Authorizations for All Behavioral Dental and ARTS Services

The Department of Medical Assistance Services (DMAS) is making significant changes to the process used the submit service authorization requests for Fee-for-Service (FFS) members. Effective November 1, 2023, select providers who provide services to Medicaid and FAMIS members will suggest service authorizations to Acentra Human (formerly popular as KePro). CalAIM-BH-Initiative-FAQ-BH-Doc-Redesign

Service Authorization Forms

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

Arts Initial Assistance Authorizations Request Download
Arts Extension Favor Authorization Request Guss
Service Authority Notification Process by Managed Care Health Plan and Acentra Health

Substance Use Housing Management Registrations Forms

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

Pharmacy Services Authorization Shapes

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