**New Co-Payments for PeachCare Kids members effective
May 1, 2012. Please click here for more information.**

Provider Manual

• Georgia Provider Manual

Cultural Competency Plan

• Cultural Competency Plan

Administrative & Claims

• CMS-1500 Claim Form Instructions (HCFA)
• UB-04 Claim Form Instructions
• Chart Audit Form
• Medical Record Release Form
• Primary Care Physician (PCP) Communication Form
• Provider Complaint Form
• Provider Change Form
• W-9 (must accompany Change of Address Form)
• Interpreter Request Form

Outpatient Treatment Request (OTR) Form

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

Psychological Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Clinical

• Clinical Practice Guidelines
• Confidential Incident Report Form
• 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

Frequently Asked Questions (FAQs)

• Georgia FAQs

Georgia Member Eligibility

• Verification for Member Eligibility (Georgia Department of Community Health – Web Portal)

Brochures

• Post Hospitalization Incentive Program for Children
• Perinatal Brochure

School Based Counseling Forms

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