New Standardized Fax Documents for Treatment Authorization Requests

Date: 03/14/24

Helping you care for your patient’s behavioral health needs is a top priority

MHS Health Wisconsin supports the timely completion of medical necessity reviews to supporthigh quality outcomes for our members. Providers may submit requests for services through our secure Provider Portal or fax.

To improve the efficiency of the authorization process, we moved to a standardized fax document for authorization requests.

There will be one form for Inpatient Authorization requests and a second for Outpatient Authorizations that support both behavioral health as well as physical health authorizations.

Through use of standardized forms, we reduce the number of separate forms for treatment requests and enhance the flexibility for the providers in the format of their clinical information.

Guidelines on the clinical information needed for each behavioral health service type are available on our OTR Completion Tip Sheet (PDF).

Inpatient Authorization Requests: 1-833-522-2806
Inpatient Medicaid Prior Authorization Form (PDF)

Outpatient Authorization Requests: 1-833-522-2807
Outpatient Medicaid Prior Authorization Form (PDF)

If you have additional questions or need specific support, please call Provider Services at 1-800-222-9831.