Provider Manual

• Kansas Provider Manual

Administrative & Claims

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

Cultural Competency Plan

• Cultural Competency Plan

Outpatient Treatment Request (OTR) Form

• Kansas Outpatient Treatment Request (OTR) Electric Form
• Kansas Outpatient Treatment Request (OTR) Manual Form

Psych Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Language Services Request Form

• Language Service Request

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• Incident Report Form
• Intensive Outpatient/Day Treatment Form – Chemical Dependency
• Intensive Outpatient/Day Treatment Form – Mental Health

Medical Necessity Criteria

• 2010 Cenpatico Medical Necessity Criteria

Best Practice Intervention Strategies Fact Sheets

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

Provider Portal (Online Claims)

• Cenpatico Secure Web Portal Manual
• Trading Partner Profile

Reference Guides

• Kansas Provider Quick Reference Guide

Frequently Asked Questions (FAQ’s)

• Kansas FAQ’s
• Kansas Community Based Services FAQ’s

Brochures

• Keeping Children Safe in the Home
• Post Hospitalization Incentive Program for Children
• Perinatal Brochure

School Based Counseling Forms

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