NEW! BHSI Grievance and Appeal Form - for login access to the BHSI Provider Network.
Provider Network Registration Form - for login access to the BHSI Provider Network.
Providers must report all reportable Significant Incidents following a centralized two-step process:
Philadelphia Department of Behavioral Health Significant Incident Report Form
Authorizations Request Instructions effective 2/13/2019 - This document provides instructions for submitting requests for approvals, authorizations and other documents. BHSI will no longer accept faxes after 3/1/2016. Update 3/8/2016 Powerpoint from Trainings
BHSI Claims Appeal Form
MA Exception Process
BHSI Concurrent Review Form - This form is used to provide the information needed for a detoxification authorization
BHSI Authorization to Release Information Form - This is the only version of the form that will be accepted by BHSI.
Authorization to Release Provider Notice. 02/2018
NEW! Drug and Alcohol Client Liability Determination Form - DDAP document for Client Liability (.pdf)
NEW! Client Liability Determination Form (Excel)
NEW! Request for Liability Reduction or Elimination Form-DDAP document for Client Liability Reduction
DDAP-EFM-1005a Client Admission Licensed Program Codes
DDAP-EFM-1005b Client Admission Detailed Drug Codes
DDAP-EFM-1008 Case Management Service Plan
DDAP-EFM-1009 Grievance and Appeal Reporting
DDAP-EFM-3000 Clinical Supervision Training Registration Form
DDAP Terms And Conditions Appendices A-E (PA-6)
Department Of Drug And Alcohol Programs specified clauses included in all provider agreements.
Department of Drug and Alcohol Programs Training Site (DDAP TMS)
Learn about and sign up for DDAP trainings.
Department Of Drug And Alcohol Programs Responsibilities of the Provider (PA-4)
BHSI Authorization to Release Information Form (Consent) NEW!