Service Authorization Request for Change in Level of Care

Requests for Change in Level of Care should be submitted using the Change in Level of Care form. Please submit to the RECON fax queue for review.

Requests for Extension of Services for the same level of care can be submitted as an authorization request through RECON.
Creation date: 3/12/2018 5:00 PM ()      Updated: 3/12/2018 5:00 PM ()
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Service Authorization Request for Change in Level of Care - Locked.docx