Provider Notice – Correction: Cenpatico is planning to enhance the edits in our claims processing system to more closely align our system’s edits with KMAP standards. Please click here to see more information.

Provider Manual

• Kansas Provider Manual

Kansas Provider Brochure

•  Kansas Provider Brochure

Administrative & Claims

• CMS-1500 Claim Form Instructions (HCFA)
• UB-04 Claim Form Instructions
• Chart Audit Form
• How to Avoid Denied Claims Related to Authorization Issues
• 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)

• Outpatient Treatment Request (OTR)
• Outpatient Treatment Request (OTR) Training Presentation
• Outpatient Treatment Request (OTR) Tips Sheet

Electroconvulsive Therapy Form

• Kansas Electroconvulsive Therapy Form

Psych Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Interpreter Request Form

• Interpreter Request Request

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• 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.
• Provider Mailing: Updated Medical Necessity Criteria Coming Feb. 1, 2011

Best Practice Intervention Strategies Fact Sheets

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

Reference Guides

• Provider Quick Reference Guide

Frequently Asked Questions (FAQs)

• Kansas FAQs
• Kansas OTR FAQs
• Kansas Claims and Authorization FAQs
• Kansas Community Based Services 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