Forms required for Psychological Testing Requests Smoky Comprehensive Psychological Clinical Purpose of Funding SAR Testing Assessment or Note Testing Source Required? Authorization Psychiatric Request Form Assessment Required? Required? State Yes Yes Yes Refer to Yes - after 9 Smoky Psychological hours Level of Testing - General Medicaid Yes Yes within 12 Care months Guidelines on website State Yes No No Psychological Testing to Refer to determine the Yes - after 9 Smoky presence/ hours Level of Medicaid No No absence of IDD within 12 Care months Guidelines on website Invoice process with contracted providers - State No No No contact Rachael Smith X Psychological Testing for LOC 1139 for to determine questions Innovations Eligibility Refer to Yes - after 9 Smoky hours Level of Medicaid No No within 12 Care months Guidelines on website
Forms required for Psychological Testing Requests Purpose of Testing Funding Source SAR Required? Smoky Psychological Testing Authorization Request Form Required? Comprehensive Clinical Assessment or Psychiatric Assessment Required? Note Psychological Testing - General State Yes Yes Yes Medicaid Yes - after 9 hours within 12 months Yes Yes Refer to Smoky Level of Care Guidelines on website Psychological Testing to determine the presence/ absence of IDD State Yes No No Medicaid Yes - after 9 hours within 12 months No No Refer to Smoky Level of Care Guidelines on website Psychological Testing for LOC to determine Innovations Eligibility State No No No Invoice process with contracted providers - contact Rachael Smith X 1139 for questions Medicaid Yes - after 9 hours within 12 months No No Refer to Smoky Level of Care Guidelines on website
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