Supplemental Treatment Forms

In keeping with the principles of evidence-based medicine, UMBH has embarked on an initiative to improve the quality of our utilization management practices and increase adherence to our clinical services, policies, and procedures. The principal focus of the initiative is to obtain complete clinical information and outcome data from our providers for the authorization of outpatient care. UMBH is also concerned with the judicious use of behavioral health benefits for those members who have limited benefits.

In order to avoid delays in the authorization process UMBH providers should complete Outpatient Treatment Review Forms along with the age-appropriate outcome measure. As always, should you or our enrollee disagree with a utilization decision, the appeal process should be used.

Please read the UMBH Quick Guide for individual UMBH Poviders and CMHCs to help you navigate the authorization process and eliminate delays in obtaining authorizations. The following supplemental treatment forms have been added to improve our ability to obtain necessary clinical information and to enable us to make better-informed authorization/utilization decisions.

Transition/Termination/Discharge Plan
Maintenance Treatment Plan
Family Therapy Treatment Plan
Split Treatment Coordination Plan (for Multiple Providers)
FARS/CFARS Summary of Scores Form (NEW) - Medicaid Only