BCN Behavioral Health Continuing OTR Form 2026

1. Click ‘Get Form’ to open the BCN Behavioral Health Continuing OTR Form in the editor.
2. Begin by entering the member's name, number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill out the treating clinician's details, including their type (MD/DO, psychologist, LPC, etc.) and name. If applicable, include the supervising provider's name.
4. Indicate whether the authorization is for an individual or organization by selecting the appropriate option and providing NPI numbers where required.
5. Complete sections regarding treatment history and current therapy modality. Specify how long the member has been in treatment and select from options like CBT or DBT.
6. Document current psychiatric medication management details, including prescriber information and adherence to medications.
7. Finally, review all entries for accuracy before signing and attaching the completed form to your case in e-referral.

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