Forms

Provider Resources Forms

DDAP Forms

Manuals and Service Agreements

BHSI Provider Network

The BHSI Provider Network allows you to submit claim files, retrieve adjudication files and obtain approval codes for services.

BHSI has made significant changes in operating procedures. Click here to see a copy of the letter sent to providers the week of 2/22/2016. A copy of the instructions of using the new forms can be found here.

Provider Resources - PA Department of Drug and Alcohol Programs

DDAP-EFM-1000 Screening Tool Part 1 Client Profile

DDAP-EFM-1001 Screening Tool Part 2 Client Screen

DDAP-EFM-1002 ASAM Summary Sheet

DDAP-EFM-1004 Authorization

DDAP-EFM-1005 Client Admission

DDAP-EFM-1005a Client Admission Licensed Program Codes

DDAP-EFM-1005b Client Admission Detailed Drug Codes

DDAP-EFM-1006 Services Rendered

DDAP-EFM-1007 Client Discharge

DDAP-EFM-1008 Case Management Service Plan

DDAP-EFM-1009 Grievance and Appeal Reporting

DDAP-EFM-3000 Clinical Supervision Training Registration Form

DDAP Terms And Conditions Appendices A-E (PA-6)
Department Of Drug And Alcohol Programs specified clauses included in all provider agreements.

Department of Drug and Alcohol Programs Training Site (DDAP TMS)
Learn about and sign up for DDAP trainings.

Department Of Drug And Alcohol Programs Responsibilities of the Provider (PA-4)

BHSI Authorization to Release Information Form (Consent) NEW!