ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Inpatient Admission Notification and Prior Authorization Request Form (PDF)
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 1531 - 1540 လၢ 3470 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Early Intensive Behavioral Intervention (EIBI) Services Pre-Authorization Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Inpatient Rehabilitation & Skilled Nursing Facility Admissions Prior Authorization Request Form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Long Term Acute Care (LTAC) Facility Admissions Prior Authorization Request Form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Substance Use Disorder Concurrent Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Substance Use Disorder Treatment Initial Authorization Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Childrens Residential Concurrent Request form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Childrens Residential Initial Authorization Request form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
MN Universal OP Mental/Chemical Health (fax to 651-662-0854) (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Home Health Care Pre-Authorization/Prior Approval Request Form (PDF)