SASS/FSP Coordinator - Prior Authorization
If the care plan determines that residential treatment is an appropriate option, the FSP Coordinator will submit a request for prior authorization to eQHealth. You must first receive an approval letter from eQHealth to submit along with your RAP to a Residential Treatment Facility.
Please fax the following four, required documents to eQHealth at (800) 418-4039, using Subj: FSP RTF Prior Auth:
1. Completed eQHealth’s Prior Authorization Form (click here)
2. Copy of Psychiatric Evaluation
- Dated within the last 90 days
- Includes mental status evaluation
- Specific principal diagnosis and other diagnoses
- Most current medication list
- Treatment summary and recommendations
3. Copy of Psychological Evaluation
- Dated within last 18 months
- Must include IQ testing
4. Copy of the current IATP (includes MHA and ITP); OR the IM+CANS
For additional information/steps to request prior auth, please click here to download a copy of the training presentation.