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  REVISED Outpatient Treatment Report (OTR) Forms  

orange.jpgThese revised OTR forms are now in use! Please update immediately because after April 30, 2012, only these revised OTR forms will be accepted.

All Maryland providers: Please continue to use your mandated State of Maryland Uniform Treatment Plan Form to request outpatient authorizations. The new standard OTR does NOT replace any mandated form (e.g. Maryland) or specialized OTR forms (KY CMHC OTR, Autism OTR, PA Substance Abuse OTR).

  • Standard OTR Form

  • Pennsylvania Substance Abuse OTR Form

  • CoventryCares of Kentucky OTR Form [This form is for KY CMHC providers only. KY non-CMHC providers: please use the Standard OTR Form.]

  • Autism OTR Form

    For additional information including an OTR instructional tool, click here.

    Any questions? Please call Provider Relations at our new direct, toll-free Provider Relations number: 855.995.4086.

  •   OTR Instructions and Hints  

    More information about OTRs, Billing, and Authorization updates related to Mental Health Parity, please click here.

  • OTR Overview and Instruction

  • Maryland Providers OTR Instructions

  • CoventryCares of Kentucky OTR Instructions

  • Autism Services OTR Instructions

    OTR Instruction Tool: includes "How to Complete balloons” when the cursor is moved over a specific area on the OTR

    OTR Helpful Hints
  •   OTR Additional Information  

    green.jpgThe revised OTR includes MHNet’s new designated, toll free fax number for OTR submissions to improve accessibility and reporting capabilities. The new fax number, along with an additional area to note your fax number for any OTR communication needs, have been added to the bottom of the revised OTR. You will also notice that radial buttons have replaced the lines used to indicate the severity of symptoms for each clinical area.

    Providers should always use the OTR process to obtain authorizations, as opposed to a phone request.

    Please note the most common OTR error is failing to record the full diagnosis, including the GAF score. Just click here to find more Helpful Hints.

    MHNet’s turn-around time goal for processing OTR’s (except where otherwise mandated) is approximately 10 business days. If there are any concerns that an OTR has not been received, you can speak with Customer Service or fax the OTR with the original fax cover sheet confirmation to our troubleshooting team at 512.340.4213 for resolution and they will be in touch with you. It is recommended that you wait at least two (2) weeks before considering an OTR as possibly lost.

    Remember, some service codes do not require prior authorization due to parity, such as the CPT 90801 and CPT 90862. For a complete list of these service codes, click here.

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