Information for Providers
Below you will find forms, policies, and resources for TMBH-ASO Network Providers.
Forms and Checklists
Non-crisis behavioral health services request forms. Prior to the initiation of any type of non-crisis behavioral health service, once the individual has been identified as Medicaid ineligible, a Non-Medicaid Request Form , or a Non-Medically Necessary Request Form (for services which medical necessity does not apply), and the Thurston-Mason BH-ASO Non-Medicaid Services Form must be completed and submitted, in an editable format, via an encrypted email to firstname.lastname@example.org.
SUD residential and withdrawal management contractors shall ensure the minimal data elements for admission, utilization review/continued stay, and discharge are reported to Thurston-Mason BH-ASO for all individuals pre-authorized (using the Non-Medicaid Request and TMBH-ASO Non-Medicaid Services forms). These data elements must be submitted via an encrypted email to email@example.com using the following forms:
TMBH-ASO Residential Client Admission v1: reported for any client admitted into services within 5 business days of admit.
TMBH-ASO Residential Services Utilization Review v1: reported at least two business days prior to expiration of initial authorization period.
TMBH-ASO Residential Client Discharge v1: reported for any client discharged from services within 5 business days of discharge.
TMBH-ASO Residential Service Activity Log v1: submit an updated log for each invoice period, including, all new admissions and discharges and submit with the invoice.
TMBH-ASO WM Client Admission v1: reported for any client admitted into services within 5 business days of admit.
Thurston Mason BH-ASO Policies