• CLAS Standards and Self-Assessment Checklist

• Critical Incident Reporting Form

• Provider Data Certification Form

• Exclusion Attestation Form

• Non-Medicaid ITA Notification Form

• Non-Medicaid ITA Concurrent Review Form

• Non-Medicaid ITA Discharge Form

• Deliverable Financial Report

• TMBH-ASO Data Dictionary

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For any medically necessary or non-medically necessary service for an Individual accessing non-Medicaid funds (and the funds are not in the provider’s contract), call Thurston Mason BH-ASO (360-763-5828) and request a screening related to the Non-Medicaid Request Form or Non-Medically Necessary Request Form. This is to verify available funding and criteria met for services.

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