**Click here for information regarding the transition of
CeltiCare Bridge Members to the Commonwealth Care Plan
effective March 1, 2012**

Important Notice:

Providers that are contracted with Cenpatico under a “Facility Provider Agreement” should bill claims with the organization’s NPI number in box 24-J of the claim form, not the NPI number of the provider rendering the service. Claims for providers contracted at the facility-level that contain the rendering provider’s NPI number in box 24-J will deny. Denied claims may be resubmitted in accordance with the claims resubmission process outlined in the Claims section of the Massachusetts Provider Manual.

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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
• SMART Goals – Fact Sheet

Interpreter Request Form

• Interpreter Request Form

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.
• Massachusetts Medical Necessity Criteria – Applied Behavior Analysis

Frequently Asked Questions (FAQs)

• Massachusetts FAQs

Quick Reference Guide (QRG)

• Massachusetts QRG

Cultural Competency Plan

• Cultural Competency Plan

Outpatient Treatment Request (OTR) Forms

• Outpatient Treatment Request (OTR)
• Outpatient Treatment Request (OTR) – Training Presentation
• Outpatient Treatment Request (OTR) Tips Sheet
• Outpatient Treatment Request (OTR) – Autism
• Intensive Outpatient/Day Treatment Form – Chemical Dependency and Mental Health

Electroconvulsive Therapy Form

• Massachusetts Electroconvulsive Therapy Form

Psychological Testing Forms

• Massachusetts Psychological Outpatient Testing Form
• Massachusetts Neuropsychological Testing Form

Administrative

• PCP Communication Form
• Provider Complaint Form
• Provider Change Form
• W-9 Form

Brochures

• Perinatal Brochure

School Based Counseling Forms

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

Best Practice Intervention Strategies Fact Sheets

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

**Effective June 15, 2012: New Claims Submissions Requirements**

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