Substance use disorder treatment authorizations

For information on authorization and billing for specific types of substance use disorder treatment, see these pages under Procedures & services > Behavioral health > Substance use treatment:

Behavioral health fax process

Send a separate fax for each individual patient. Faxes referencing more than one patient will be returned for resubmission.

  1. Complete the form for the service you're requesting and use it as the cover sheet for your fax.
    Inpatient Prior Authorization Form  or  Outpatient Service Request Form
  2. Identify the evaluating facility/agency contact's name and phone number on the auth form/cover sheet.
  3. Attach complete clinical notes or the screening form to ensure that we have all available clinical data to review.

Requirements for clinical notes

Computer-generated or typewritten notes are preferred. Hand-written documentation may delay the review process and require extra phone calls to clarify information and clinical content. 


  • CIWA or COWS score if available
  • All vitals including blood pressure, pulse, temperature and respirations
  • Any specific withdrawal symptoms that the patient is currently exhibiting
  • The specific dates of any transfers from one level of service to another

Response turnaround times

We don't typically process requests during the lunch hour, but a requesting facility will receive a response fax within 1 business day.

  • Fax us before 11:00 a.m. - Same-day response
  • Fax us after 2:00 p.m. - Response by 11:00 a.m. next business day
  • Fax us after 4:00 p.m. - Response by 2:00 p.m. next business day