Florida
Provider Manual
Covered Services and Authorization Grid
Cultural Competency Plan
Language Services Request Form
Administrative & Claims
- Chart Audit Form
- CMS 1500 Claim Form Instructions
- Electronic Funds Transfer (EFT) Agreement
- Medical Record Release Form
- Member Written Consent for Appeal
- Provider Change Form
- UB 04 Claim Form Instructions
- W-9 (must accompany Provider Change Form)
Florida OTR Form
- Florida Outpatient Treatment Request (OTR) Electronic Form
- Florida Outpatient Treatment Request (OTR) Manual Form
Psych Testing Forms
Clinical
- Cenpatico FARS/CFARS Memo
- Clinical Practice Guidelines
- Practice Parameters
- Intensive Outpatient/Day Treatment Form – Chemical Dependency
- Intensive Outpatient/Day Treatment Form – Mental Health
Medical Necessity Criteria
Best Practice Intervention Strategies Fact Sheets
Provider Portal (Online Claims)
Reference Guides
FAQs
Brochures
- Keeping Children Safe in the Home
- Post Hospitalization Incentive Program for Children
- Perinatal Brochure
School Based Counseling Forms


