Provider Manual

• Ohio Provider Manual

Updated Pharmacy Benefit Information

• Quick Reference Drug List
• Carve-In Reference Sheet
• Carve-In Frequently Asked Questions

Administrative & Claims

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

Out of Network Providers

• Out of Network Provider Guidelines

Best Practice Intervention Strategies Fact Sheets

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

Cultural Competency Plan

• Cultural Competency Plan

Outpatient Treatment Request (OTR)

• Outpatient Treatment Request (OTR)
• Outpatient Treatment Request (OTR) Tips sheet
• Outpatient Treatment Request (OTR) – Training Presentation

Intensive Outpatient/Day Treatment Forms

• Intensive Outpatient/Day Treatment Form – Chemical Dependency and Mental Health

Interpreter Request Form

• Interpreter Request Form

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• Incident Report Form
• SMART Goals – Fact Sheet

Psych Testing Forms

• Psych Testing Form – Inpatient
• Psych Testing Form – Outpatient
• Ohio Neuropsych Testing 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.

Quick Reference Guides (QRG)

• Ohio Quick Reference Guide

Frequently Asked Questions (FAQs)

• Ohio 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