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Dialectical Behavior Therapy (DBT) Authorization Request Form - primewest

Dialectical Behavior Therapy (DBT) Authorization Request Form - primewest 2025

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The document is an authorization request form for Dialectical Behavior Therapy (DBT) services for PrimeWest Health members. It outlines the necessary criteria for eligibility, including age, diagnosis, and mental health needs. The form requires detailed member and provider information, treatment requests, and verification of certification with the Minnesota Department of Human Services. Submission does not guarantee approval, and incomplete forms will be returned.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is responsible for obtaining preauthorization?

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.

How do you initiate prior authorization?

A denied prior auth request can occur when a providers office submits a wrong billing code, misspells a name or makes another clerical error. Requests can also be denied if the prior auth request lacks sufficient information about why the medication or treatment is needed.

What is the phone number for PrimeWest?

PrimeWest Health Provider Contact Center: 1-866-431-0802 (toll free)

How do I get preauthorization for therapy?

Submission of Request: Typically, your physician will submit a prior authorization request to your insurance company. Another healthcare provider can also do this. The request usually includes details about your condition, the proposed treatment plan, and why its necessary.

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