Provider Manual

• Florida Provider Manual  

Covered Services and Authorization Grid

• Florida Covered Services and Authorization Grid

Cultural Competency Plan

• Cultural Competency Plan

Interpreter Request Form

• Interpreter Request Form

Administrative & Claims

• Chart Audit Form
• CMS 1500 Claim Form Instructions
• Medical Record Release Form
• Member Written Consent for Appeal
• PCP Communication Form
• Provider Change Form
• Provider Complaint Form
• UB 04 Claim Form Instructions
• W-9 (must accompany Provider Change Form)

Florida OTR Form

• Florida Outpatient Treatment Request (OTR)
• Florida Outpatient Treatment Request (OTR) Training Presentation

Electroconvulsive Therapy Form

• Florida Electroconvulsive Therapy Form

Psych Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• Intensive Outpatient/Day Treatment Form – Chemical Dependency and Mental Health
• SMART Goals – Fact Sheet

Medical Necessity Criteria

• 2011 Cenpatico Medical Necessity Criteria – Private Day Treatment and Community-Based Services
• *Note* – Effective February 1, 2011, Cenpatico, in association with InterQual, will begin enforcing new Medical Necessity Criteria for Behavioral Health. To see answers to Frequently Asked Questions (FAQ) regarding the change, please click here.

Best Practice Intervention Strategies Fact Sheets

• Alcohol and Other Drug (AOD)
• ADHD
• Adjustment Disorder
• Anxiety
• Bipolar
• Depression
• OCD
• ODDCD
• PTSD

Reference Guides

• Florida Quick Reference Guide

FAQs

• Florida FAQs

Brochures

• Post Hospitalization Incentive Program for Children
• Perinatal Brochure

School Based Counseling Forms

• School Based Counseling Fax Data Request
• School Based Counseling ROI Form