Companion Benefit Alternatives, Inc.

Welcome to the Form Resource Center for Behavioral Health Clinicians

Choose a Category

• Facility-Based Treatment

  Use this form to request certification for both mental health and substance use disorder treatment for inpatient, residential treatment (RTC), partial hospitalization (PHP), intensive outpatient (IOP) or outpatient electroconvulsive therapy services.

• Outpatient Medication Management

  Use this form to request certification for outpatient medication management CPT codes. Do not use this form to request individual or group therapy. Only providers with prescriptive authority should use this form.

• Outpatient Mental Health Treatment

  Use these forms to request certification for outpatient mental health treatment services (e.g. individual or group therapy). Do not use these forms for services related to substance use disorder (SUD), intensive outpatient programs (IOP) or partial hospitalization programs (PHP).

• Outpatient Substance Use Disorder Treatment

  Use this form to request certification for outpatient substance use disorder (SUD) treatment services (e.g. individual or group therapy). Do not use this form for mental health treatment requests, intensive outpatient programs (IOP) or partial hospitalization programs (PHP).

• SC Department Of Mental Health Treatment

  Use these forms to request certification for all SC Department of Mental Health outpatient services.

• SC Certified EmPATH Units

  Use this form to request treatment at a SC Certified EmPATH unit.