Cenpatico is pleased to partner with CeltiCare Health Plan of Massachusetts, Inc. (CeltiCare). The information below was developed and is maintained to assist our provider network in the delivery of comprehensive care to our members. Please do not hesitate to contact Cenpatico should you have any questions or require additional information. Be sure to check back periodically for new content or network updates.

Provider Manual

• Massachusetts Provider Manual

Covered Professional Services & Authorization Grid

• Covered Professional Services & Authorization Grid

Clinical

• Clinical Practice Guidelines

Medical Necessity Criteria

• 2010 Cenpatico Medical Necessity Criteria

Frequently Asked Questions (FAQs)

• Massachusetts FAQs

Quick Reference Guide (QRG)

• Massachusetts QRG

Outpatient Treatment Request (OTR) Forms

• Massachusetts Outpatient Treatment Request (OTR) – Electronic Form
• Intensive Outpatient/Day Treatment Form – Chemical Dependency
• Intensive Outpatient/Day Treatment Form – Mental Health

Psychological Testing Authorization Request Form

• Psychological Testing Authorization Request Form – Inpatient
• Psychological Testing Authorization Request Form – Outpatient

Forms

• Provider Complaint Form
• Language Request Form

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

Providers sending First Time Claims & Adjustments for CeltiCare please mail to:

PO Box 7200 Farmington, MO 63640-3813

For Providers sending Appeals for CeltiCare please mail to:

PO Box 6000 Farmington, MO 63640-3809

To reach us by phone please call:

Claims: (866) 324-3632