News

Changes to Partial Hospitalization Program (PHP) Benefits, Billing, and Authorization

Date: 02/15/2017

According to Wisconsin Forward Health, Partial Hospitalization Program (PHP) billed with Revenue Codes, 912 and 913 is not a covered benefit under Medicaid. Effective March 1, 2017, Revenue Codes, 912 and 913 will no longer be covered by Cenpatico. Day Treatment services billed as H2012 on form CMS 1500, is a covered benefit.  In order to provide this service, the provider must be certified by the State of Wisconsin, Department of Health Services (DHS) as a Community Substance Abuse Services (CSAS) Day Treatment DHS 75.12, Mental Health Day Treatment DHS 61.75 or Mental Health Day Treatment for Children 40.11 (2) (A, B, or C) provider.

Providers must also be registered on the Forward Health Portal with a Provider Type and Provider Specialty for Day Treatment, and must bill these services to Cenpatico per the Forward Health rules. Day Treatment services require authorization. Requests for Day Treatment Services are submitted in writing utilizing the Intensive Outpatient/Day Treatment Form Mental Health/Chemical Dependency. The form is located on the Cenpatico website www.cenpatico.com under Provider Tools then choose the Provider Forms tab. You may fax the authorization request form to 866-694-3649, or submit it electronically via the Cenpatico web portal.

Should you need additional assistance, please contact Customer Service at 800-589-3186. Thank you for being a valued partner.

Best Regards

Network Operations Team