Attention Referents of Section 97 Appendix E Private Non-Medical Institution (PNMI) Services

Sep 16, 2025

Effective September 16, 2025, referrals for Section 97, Appendix E, PNMI Services will not undergo clinical review until referents submit all required documentation through the Atrezzo system. Acentra will place incomplete referrals on an administrative hold for up to seven days.

Ensuring Referral Processing

• If referents submit the required documentation within the seven-day administrative hold period, the referral will proceed to clinical review.
• If referents do not submit the required documentation within the seven-day administrative hold period, Acentra will administratively deny the referral.

Acentra will not conduct clinical review of an administratively denied referral until referents submit all required documentation. Referents may upload missing documentation to the denied referral request in the Atrezzo system at any time; however, Acentra may adjust the request date to reflect the correct eligibility date.

Required Documentation

Required referral documentation must include the following member-specific information:

• Completed MD Physician Order Form
• The most recent Level of Care Utilization System (LOCUS) form completed within the past 12 months
• Completed Release of Information (ROI)
• Completed PNMI Referral Questionnaire

Establishing Medical Necessity with Additional Documentation

Acentra may require referents to submit additional documentation to substantiate medical necessity for members with complex presentations. When applicable, referents must also submit:

• Pertinent assessments completed within the past six months, including the date and the assessor’s signature and contact information. These may include, but are not limited to:
  • Occupational Therapy
  • Neuropsychological
  • Psychosexual
  • Psychiatric
  • Psychological  
• A recent physician rule-out statement
• Crisis evaluations, emergency department notes, inpatient notes, and discharge recommendations.
• Any other documentation requested by Acentra

For questions regarding the Atrezzo process, please contact the Acentra Health Provider Relations Department at 1-866-521-0027, Option 3, or by email. You can also chat with an Acentra Health representative through their website.