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, Risk Management Specialist, email:

Forensic Residential– Stephanie Smith, Forensic Coordinator, email:

Civil State Hospital– Stephanie Smith, Adult Behavioral Health Specialist, email:

PRTS– Elisa Bustamante, Children’s Behavioral Specialist, email: