Incidental Pre-Authorization Requests
Incidental/Residential Pre-Authorization Request Form
The following links are form field descriptions and the incidental procedure codes when completing the form above:
Descriptions of Required Fields in Pre-Authorization Request Form
For any questions or concerns on the pre-authorization process, you may contact:
Incidental Expenses, Transitional Vouchers – Miralys Martinez, Risk Management Specialist, email: mmartinez@cfchs.org
Forensic Residential – Michelle Arroyo, Forensic Coordinator, email: marroyo@cfchs.org
Civil State Hospital – Stephanie Smith, System of Care Manager, email: ssmith@cfchs.org
PRTS – Elisa Bustamante, Children’s Behavioral Specialist, email: ebustamante@cfchs.org