Behavioral Health Provider Forms

Request for Psychological Testing- .pdf format
Request for Psychological Testing- fillable form

Behavioral Health Conversion Member Letter

Intensive Outpatient Services IOP Form - Behavioral Health
Intensive Outpatient Services IOP Form - Substance Abuse
Provider Instructions for Intensive Outpatient Program Process

Behavioral Health Prior Authorization (PA) Form:
A Prior Authorization form is a quick and easy way for Delaware Physicians Care providers to request approval for medical procedures, admissions or medications. You can use this form for all prior authorization requests as long as:

• You are an in-network provider
• You are not requesting approval for a procedure scheduled to take place within the next business day

Requests from out-of-network providers and for procedures scheduled for the next business day need to be completed by phone. You can reach our PA department at 1-866-543-2383. All services rendered by an out-of-network provider are subject to prior authorization.