Ketamine Infusion Therapy Prior Authorization Request

Ketamine Infusion Therapy Prior Authorization Form

Managing prior authorization requests for innovative treatments like ketamine infusion therapy can be time-consuming and complex. This Ketamine Infusion Therapy Prior Authorization Request form template helps mental health practices, psychiatric clinics, and healthcare providers submit complete, well-documented authorization requests to insurance companies efficiently.

Built for mental health providers and insurance coordination teams

Whether you're a psychiatrist, mental health clinic administrator, or medical billing specialist, this form captures all the essential clinical information insurers require to evaluate ketamine infusion therapy requests for treatment-resistant depression. The structured format ensures you include medication trial histories, diagnostic criteria, previous treatment failures, and supporting psychiatric documentation—reducing back-and-forth with insurance companies and accelerating approval timelines.

Why Paperform for prior authorization requests?

With Paperform, you can customize this template to match your practice's workflow and your patients' insurance requirements. Conditional logic shows relevant fields based on diagnosis codes and treatment history, while file upload fields let you attach psychiatric evaluations, lab results, and supporting letters directly within the submission.

Once submitted, use Stepper to automate your follow-up workflow—send confirmation emails to referring physicians, create tracking tickets in your practice management system, set reminders for authorization follow-ups, and notify your billing team when approvals come through. This keeps your entire team aligned without manual coordination.

For practices managing multiple authorization types, you can duplicate and adapt this template for other specialty treatment requests, maintaining consistency across your authorization process while meeting each insurer's specific documentation requirements.

Secure, compliant, and professional

This form template helps you maintain organized records of authorization requests with timestamps and complete audit trails. While Paperform is not HIPAA compliant, it is SOC 2 Type II certified and offers robust security features suitable for administrative and coordination workflows in healthcare settings.

Whether you're submitting your first ketamine therapy authorization or processing dozens each month, this template provides a professional, thorough foundation that demonstrates medical necessity and improves your approval rates.