Care Management Forms

Below are links to forms used to request authorization for various services. These forms are also available, along with others, on the web-DENIS Forms page. To access the complete Forms Library, log in to web-DENIS > BCN Provider Publications and Resources > Forms.

Bariatric surgery

Behavioral health services

Drugs covered under the medical benefit

Use the Medical Benefit Drug Request form for medications covered under the member’s medical benefit.

To request authorizations for drugs covered under the pharmacy benefit, please call the BCN Clinical Pharmacy Help Desk at 1-800-437-3803.

e-referral

Transitional care services