Provider Manual

• Wisconsin Provider Manual
• Wisconsin Quick Reference Guide (QRG)

Cultural Competency Plan

• Cultural Competency Plan

Provider Changes and Credentialing

• Provider Location Change/Credentialing Instructions
• Wisconsin CAQH Application Form
• Attestation (Attachment B)
• Provider Change/Add/Term Form
• Provider Specialty Profile
• W-9 (must accompany Provider Change/Add/Term Form)
• Wisconsin Universal Application
• Provider Roster Form

Administrative

• Interpreter Listing
• Language Service Request
• Provider Complaint Form
• Incident Report Form

Outpatient Treatment Request (OTR) Form

• Wisconsin OTR Electronic Form
• Wisconsin OTR Manual Form

Intensive Outpatient /Day Treatment Forms

• Chemical Dependency
• Mental Health

Psych Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• Chart Audit Form
• Medical Release Form
• Primary Care Physician (PCP) Communication Form

Medical Necessity Criteria

• 2010 Cenpatico Medical Necessity Criteria

Claims

• Trading Partner Agreement
• CMS-1500 Claim Form Instructions (HCFA)
• UB-04 Claim Form Instructions

Provider Portal

• Cenpatico Secure Web Portal Manual

Provider Communications

• Demographic Change Memo
• Wisconsin Provider Update – Spring 09

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