Provider Resources - Forms
Provider Network Registration Form - for login access to the BHSI Provider Network.
Significant Incident Report
Providers must report all reportable Significant Incidents following a centralized two-step process:
- Report the incident by telephone to the assigned BHSI Service Manager or Service Manager's supervisor within 24 hours of the incident or upon notification of the incident's occurence.
- NEW! A copy of all reportable incidents must be emailed to BHSI.firstname.lastname@example.org of uploaded to the BHSI Quality Provider Portal. You must have an active user name and password to access.
Please do not include Protected Health Information (PHI) in the subject line of the submitted documents.
Approvals and Authorizations
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
Provider Resources - PA Department of Drug and Alcohol Programs
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!