Carelon Behavioral Health of Kansas
  • Home
  • About Us
    • Our Mission and Values
    • Careers
    • Services
  • Members
    • Achieve Solutions
    • Member Handbook
    • Provider Directory
    • Non-Discrimination Disclosure
  • Providers
    • Provider Directory
    • Fraud, Waste & Abuse
    • Free Online Training
    • PHI
    • Provider Forms
    • Provider Information
    • Provider Reports
    • Kansas Sentencing Commission (KSSC)
    • Kansas Family Crisis and Support (KSCS)
    • Kansas Specific Training Documents
  • Contact
  • Find a Provider
  • Find a Provider
Carelon Behavioral Health of Kansas
  • Home
  • About Us
  • Members
  • Providers
  • News & Events
  • Contact
Home / Providers / Provider Forms

Provider Forms

Administrative Forms

  • Member Release of Information Updated 2017
  • Sample Multiparty Release
  • W-9 (Editable Version)
  • KDADS SUD request form and Instructions

Appeals Forms

  • Kansas Administrative Appeal Form (English)
  • Kansas Administrative Appeal Form (Spanish)
  • Kansas IOP Appeal Form (English)
  • Kansas IOP Appeal Form (Spanish)
  • Kansas RTC Appeal Form (English)
  • Kansas RTC Appeal Form (Spanish)

Problem Gambling

  • Problem Gambling Provider Guide (Updated 03-19-19)
  • Kansas Problem Gambling Concurrent Form
  • Kansas Problem Gambling Discharge Form
  • Kansas Problem Gambling Intake Form
  • Kansas Problem Gambling RTC Request Form
  • Kansas Problem Gambling VEP Exit Form

Providers

  • Provider Directory
  • Fraud, Waste & Abuse
  • Free Online Training
  • PHI
  • Provider Forms
  • Provider Information
  • Provider Reports
  • Kansas Sentencing Commission (KSSC)
  • Kansas Family Crisis and Support (KSCS)
  • Kansas Specific Training Documents
Copyright © 2023 Carelon. All rights reserved.
  • Sitemap
  • Privacy Policy
  • Terms & Conditions
  • Download Acrobat Reader
  • Accessibility Information
en_USEnglish
nl_NLNederlands es_ESEspañol fr_FRFrançais it_ITItaliano de_DEDeutsch pl_PLPolski pt_PTPortuguês tlTagalog viTiếng Việt ru_RUРусский hyՀայերեն arالعربية fa_IRفارسی bn_BDবাংলা pa_INਪੰਜਾਬੀ ko_KR한국어 ja日本語 zh_CN简体中文 en_USEnglish

Welcome to Carelon Behavioral Health,
formerly Beacon Health Options

Learn more
This is default text for notification bar
Learn more