Incidental/Residential Pre-Authorization Requests

Incidental/Residential Pre-Authorization Request Form

Incidental Procedure Codes

Descriptions of Required Fields in Pre-Authorization Request Form

For any questions or concerns on the pre-authorization process, you may contact:

Incidental Expenses– Miralys Martinez, Quality Specialist, email: mmartinez@cfchs.org

Forensic Residential– Katherine Thomas, Forensic Coordinator, email: kthomas@cfchs.org

Civil State Hospital– Kristen Juliano, Adult Behavioral Health Specialist, email: KJuliano@cfchs.org

PRTS– Elisa Bustamante, Children’s Behavioral Specialist, email: ebustamante@cfchs.org