PO Box 016960 (LC-2940)
Miami, FL 33101
Tel. 305-243-3169
800-294-8642, ext. 4
305-243-7270, ext. 4
877-520-6254 TTY callers
305-243-7790 Fax
Provider Portal
UMBH Provider Manual
QI Program Overview
Provider Newsletters
Improving Care and Service
Clinical Practice Guidelines
- Major Depressive Disorders practice guidelines
- ADHD practice guidelines
- Substance Use Disorders practice guidelines
- Panic Disorder practice guidelines
- Bipolar Disorders practice guidelines
- Suicidal Behaviors practice guidelines
- Schizophrenia practice guidelines
- Management of Children with Autism Spectrum Disorders practice guidelines
- Psychiatric Consultation practice guidlines
Continuity and Coordination
- Expectations for Exchanging Information
- UMBH Exchange of Information Form
- UMBH Coordination of Care Guidelines
Medical Necessity Criteria
Cultural Competency
Utilization Management
- Utilization Management Notifications
- Standard Outpatient Treatment Forms
- UMBH Outpatient Authorization Guide
Member Rights and Responsibilities (Derechos y Responabilidades de los Afiliados)
Provider Privacy & Confidentiality
- Provider Confidentiality
- HIPAA General Rules
- UMBH Website Privacy Statement
- University of Miami Privacy Notice
Preventive Health Programs and Patient Safety Information
- ADHD Program
- MDD Program
- Targeted Care Management Program
- Post Partum Depression Program
- Patient Safety
Treatment Records
- Treatment Records
- Treatment Record Keeping Standards
- Treatment Record Review Guidelines
- Treatment Records Review Results
- Behavioral Health Documentation Manual
Florida Medicaid Information
Provider Forms
Community Links and Resources
Educational Materials
Standard and Supplemental Forms
You will need Adobe Acrobat Reader to open and fill out these forms. Please fax the completed forms to UMBH at 305-243-7299.
Suggested Forms
Outpatient Care Provider Forms
- Outpatient Clinical Review Form
- Child & Adolescent Assessment Checklist
- 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
- TBOS Services Request Form
CMHC Forms
- Medicaid Initial Clinical Review Form
- Medicaid Concurrent Clinical Review Form
- NEW FARS/CFARS Summary of Scores Form - Medicaid Only
Informed Consent for Psychotheraputic Medications (NEW)
- Provider Notification Informed Consent
- Medication Informed Consent Form for CMS Members
- Medication Informed Consent Form for SFCCN Members
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.
Supplementary Forms:
- 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