Provider Forms & Reference Documents
Administrative Forms | Clinical Forms | Inspection of Care | Reference Documents| FAQs
- Frequently Asked Questions (FAQ) (PDF)
- Online Services Account Request Form
- ProviderConnect Account Request Form for Access to Multiple Providers
- Substance Abuse Codes (PDF)
- Reconsideration Fax Request Form (PDF)
- Adult RSPMI Authorization Request for ORF2 (PDF)
- Child RSPMI Authorization Request for ORF2 (PDF)
- Impairment Scale and Risk Rating Guide (PDF)
- Non-RSPMI Outpatient Authorization Request for ORF2 (PDF)
- Change in RSPMI Primary Provider Form
- Copy of Certification of Need (CON) (PDF)
- Inpatient Treatment Report (ITR) (PDF)
- Outpatient Review Form (ORF 2) (PDF)
- Inpatient Fax Request Form
- Outpatient Fax Request Form
- Other Fax Request Form (PDF)
- Outpatient Information for Residential Requests
- Psychological Testing Form (PDF)
- Authorization Correction Request
- Service Codes and Descriptions
Outpatient
- IOC-OP-Clinical Record Review Checklist — 2012-April (PDF)
- IOC-OP-Facility Review Checklist — 2012-April (PDF)
- IOC-OP-Provider Information Form — 2012-April (PDF)
- IOC-OP-Notification Letter-2012 — April (PDF)
Inpatient
- Reference Guide: Arkansas ProviderConnect Tips
- Reference Guide: Claims Tips (Submitting Claims Successfully)
- Reference Guide: RSPMI Children Coding
- Reference Guide: RSPMI Adult Coding
- Reference Guide: RSPMI services requiring prior authorizations and extension of Benefits
- Reference Guide: Non RSPMI Coding
- Residential Request: Documents Required
- Retrospective Review: Documents to submit
- Webinar Frequently Asked Questions (FAQ) 09/02/11
- Frequently Asked Questions (FAQ) (PDF) Revised 11/09/2010
