- Web Portal Claim Submission: Participating providers can set up a user account on www.cenpatico.com to submit both professional and institutional services, as well as, to check eligibility and the status of previously submitted claims.
- EDI Clearinghouse Submission: Cenpatico’s network providers may choose to submit their claims through a clearinghouse. Cenpatico accepts EDI transactions through Emdeon (1-800-845-6592) and Capario (1-800-792-5256, X-812). Please note that the Cenpatico Payer ID Number is 68052
- Paper Claim Submission: Paper claims may be sent to:
PO Box 6800
Farmington MO, 63640
All providers are required to have an Indiana Medicaid number; however, Cenpatico requires that all services provided be billed with an appropriate NPI and Taxonomy number. Providers are required to have an Indiana Medicaid number and National Provider Identifier. Additional details on the NPI program can be found at http://www.cms.hhs.gov. Taxonomy codes are also required for claims submission.
Yes. Providers should access the form by going to www.cenpatico.com or by contacting the Indiana Provider Relations Specialist at 1-877-647-4848 X-20268 in order for the necessary forms to begin the EFT process.
Please refer to the Cenpatico Provider Manual located at www.cenpatico.com for a complete listing of the Covered Billing Codes. Please ensure you follow all applicable authorization processes when billing these codes.
A thorough review of claim reconsideration steps can be found in the Claims Reconsideration portion of the Cenpatico Provider Manual on www.cenpatico.com.
You can find these materials and forms on the Cenpatico website at www.cenpatico.com. Clinical Practice Guidelines can also be found in the Cenpatico Provider Manual.As of February 1, 2011, we will be using InterQual Criteria for mental health
– both adult and pediatric guidelines. There will be no changes to the Community-
Based Services criteria and we will continue to utilize the American Society of Addiction Medicine’s (ASAM) criteria for substance abuse MNC. InterQual is a nationally recognized instrument that provides a consistent, evidence-based platform for care decisions, and promotes appropriate use of services and improved health outcomes. Many of you may already be familiar with these MNC or have these national standards.
Cenpatico Network Development and Clinical Provider Trainer are available to conduct provider forums, orientations, or individual training on topics such as best practices, current trends, integration with physical health, forums, and Cenpatico policies & procedures. Please call Cenpatico Provider Relations at 1-877-647-4848 if you would like further information regarding upcoming training events in your area. Cenpatico is an approved CEU provider. Additionally, Cenpatico offers on-line training through E-Learning.
Our Case Managers and Care Coordinators assist members in finding network roviders, coordinate appointments and follow up reminders. For those members at risk for readmission who do not have a phone, a preprogrammed cell phone is provided to keep members and providers connected through the Caring Voices Program. Cenpatico has also developed other incentive programs to ensure members follow
treatment recommendations to increase the likelihood of positive outcomes.