Treatment Plan Update Needed Now Hiring State-Wide Make A Referral Areas We Serve Frequent Questions Make A Payment To Have Someone Else Complete the Treatment Plan Update for Your Client Client First Name(Required)First 5 Letters of Client's Last Name(Required)Insurance ID(Required)Insurance/Pay Source(Required)Select Primary Pay SourceMedicaid or Managed Care PlanSelf-Pay or Pro BonoAetnaAlliance CoalAllied NationalBlueCross Blue ShieldChampVACigna EAP ServicesCigna Health and Life Insurance Co.Edison Health SolutionsGPAGroup Benefit Services (GBS)Health SmartHealthcare HighwaysHealthCare Solutions GroupHealthChoiceHealthScopeHealthSmartHealthSmart Benefit SolutionsHumanaChoice PPOHumana MilitaryMedicaMedicare - Aetna CoventryMedicare - HumanaMedicare - Other Supplemental PlanMedicare - OriginalMeritain HealthThe Kempton GroupTricare EastUMR - Wausau/UHISUnited Health Care/United Behavioral HealthUHC MedicareWebTPAOtherClient Payment Amount(Required)Please indicate how much the client pays per session so the therapist that is updating the treatment plan knows how much to charge the client. CLIENT'S (or Guardian's) Current Phone Number(Required)Client/Guardian Email Address(Required) Date current tx plan expires(Required) MM slash DD slash YYYY This field is hidden when viewing the formMedicaid IDOnly clients with Medicaid as one of their payment sources need treatment plan updates. If the client does not have medicaid as a pay source, please complete a 6 month survey and submit a Simple Treatment Plan request using the CDC Request form.Parent or Guardian's Name if the Client is a Minor First Last Clinician Email(Required) Clinician Making Request(Required) Full Name Do you have a preference on who updates the treatment plan?(Required) Yes No Name of clinician you would like to complete the treatment plan update(Required) Δ