Please click here to access Cenpatico’s Winter 2011 Provider Newsletter.

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
• Attachment B – Provider Attestation
• Wisconsin CAQH Application Form
• Collaborating Physician Statement for APNPs and PAs
• PCP Communication Form
• Provider Change Form
• Provider Specialty Profile
• W-9 (must accompany Provider Change/Add/Term Form)
• Wisconsin Universal Application
• Provider Roster Form

Administrative & Claims

• Incident Report Form
• Click here to review the MHS-Wisconsin Translators/Interpreters List
• Interpreter Request Form
• Provider Complaint Form
• CMS-1500 Claim Form Instructions (HCFA)
• UB-04 Claim Form Instructions

Outpatient Treatment Request (OTR)

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

Intensive Outpatient /Day Treatment Forms

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

Psych Testing Forms

• Inpatient Psychological Testing Request
• Outpatient Psychological Testing Request

Electroconvulsive Therapy Form

• Wisconsin Electroconvulsive Therapy Form

Clinical

• Clinical Practice Guidelines
• Practice Parameters
• Chart Audit Form
• Medical Release Form
• 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.

Best Practice Intervention Strategies Fact Sheets

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

Provider Communications

• Demographic Change Memo
• Wisconsin Provider Newsletter – Spring 2009
• Wisconsin Provider Newsletter – Fall 2010

Brochures

• Post Hospitalization Incentive Program for Children
• Perinatal Brochure

School Based Counseling Forms

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

Fall 2011