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Adult BH HCBS End User Training for New Customers - Authorization Request Form - Service Requested

  • Aug 13, 2025 1:51 PM UTC
  • Aug 18, 2025 7:37 PM UTC
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Ensora Education Team
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Click here to return to the Adult BH HCBS End User Training for New Customers table of contents

 

  • For additional information on the form click on form help.
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  • Checked fields indicate required information.  2.png
  • Select only the Service type associated with the patient’s program on this chart. In this example, it is Peer Supports Service.

    3.png

 

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