Phoenix Connections – IOP

401 Clairborne Road
Olathe, Kansas 66062

Hours: Monday – Thursday, 4:00 p.m. to 7:00 p.m. with required parent/caregiver sessions on Thursdays

Holiday hours may vary. Check with Program Director for details.

Referral Form

To be completed by mental health professionals only; parents/caregivers may contact our program director at 913-324-3611

Initial Authorization & Concurrent UR Form

Referrals By Phone: (913) 324-3658
Referrals By Fax: (913) 768-1437

At this time, IOP accepts Kansas Medicaid* and private pay for services. Unfortunately, the program is not paneled with commercial insurances like BCBS, Cigna, Aetna, etc. and would be considered out-of-network.

Beginning January 1, 2019, Aetna will still be considered out-of-network briefly, while their contract is being established.

PERSONAL INFORMATION

INSURANCE INFORMATION



AUTHORIZATION TYPE

REFERRAL INFORMATION

Note that for all of the following questions, the likelihood of an authorization is improved when specific examples of the behaviors are provided.

RISK











FUNCTIONING






CO-MORBIDITY



RECOVERY ENVIRONMENT



RESILIENCY & TREATMENT HISTORY






ACCEPTANCE & ENGAGEMENT IN TREATMENT





FOR UTILIZATION REVIEW PURPOSES ONLY


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