FAQs

Cenpatico, a division of Centene Corporation, is one of the nation’s most experienced behavioral health companies providing behavioral healthcare services through a comprehensive network of qualified providers. Cenpatico, established in 1994, customizes behavioral health solutions by providing its clinical and administrative expertise to governmental entities, health plans and employers.

Cenpatico manages CFC member benefits for members in the following Ohio service delivery areas; East Central and Northwest regions. For ABD, we manage East Central, Northeast and Southwest regions.

Buckeye Community Health Plan manages the physical health benefits for Cenpatico members. You can visit the BCHP website at www.bchpohio.com.

Members and providers can call 800-224-1991.

Members may call 866-246-4358 and providers may call 866-296-8731.

Contact Our Cenpatico Network Development at 800-224-1991 or email the department at nwilder@cenpatico.com.

Providers that wish to render covered services to Cenpatico members must have a Medicaid Number. In certain circumstances, we can apply for a Medicaid Reporting Number on the Provider’s behalf.

You may join on an individual or group basis. If you are in a practice with at least one other provider and share a Tax Identification Number, you may contract as a group. Please note that each provider within the group must sign an attestation form and complete Cenpatico credentialing.

Please call Ohio Provider Relations at 800-224-1991 to request a Provider Manual or you may download one under Provider Tools. The Manual contains information such as Cenpatico Medical Necessity Criteria, Clinical Practice Guidelines, and policies and procedures regarding Credentialing, Utilization Management, Quality Improvement, and Claims.

Please call Provider Relations at 800-224-1991 and request a Provider Change Form or go to the Provider Tools section on the Cenpatico website. This form will allow you to change your provider demographics. Once you complete the form, simply fax it to 866-719-5436, along with an updated W-9 Form.

Cenpatico Network Development and Provider Relations are available to conduct orientations, and individual training to our Ohio provider network on Cenpatico policies & procedures. We also offer online courses through Relias Learning on our website. Please visit the Education and Training section for more information.

Ohio providers must have an application on CAQH. Cenpatico can obtain a CAQH number for a provider if needed. Providers must also have State of Ohio Medicaid number. Cenpatico credentialing packets include a Provider Specialty Profile, W9, and Attachment E- Provider Attestation (for those providers joining a contracted group/clinic). There is a separate application for hospitals and facilities- please request this form from your Provider Relations Specialist.

The credentialing process can take up to three (3) months. Upon completion of the credentialing process, you will receive written notification of your credentialing status, along with your effective date as a participating provider in the network.

Cenpatico re-credentials each provider/facility every three (3) years from the date of their initial credentialing date. For example, if you were credentialed on January 1, 2006, your credentialing would need to occur before January 31, 2009.

Cenpatico employs a team of Customer Service Representatives (CSR) who refer members to our providers. Referrals are tailored to the member’s needs, and provider specialty and location are taken into consideration. Members may self refer.

Participating providers are allowed an evaluation/assessment (90801) and 5 outpatient visits prior to needing an authorization. All services after the initial evaluation and 5 outpatient visits must be authorized. Authorization is obtained by completing an Outpatient Treatment Request (OTR) which can be found in the Form Section of the website. You can also call 800-224-1991 and request an OTR.

Prior authorization is not required for the following CPT codes for contracted Psychiatrists or Advanced Practice Nurse Practitioners:

90801/90802- Diagnostic Interview Examination Limited to one per 6 months
90862-Pharmacologic Management
90805-Individual Therapy (20-30 minutes) with med eval/mgmt services
90807-Individual Therapy (45-50 minutes) with med eval/mgmt services
90811-Individual Therapy, interactive (20-30 minutes) with med eval/mgmt services
90813- Individual Therapy, interactive (45-50 minutes) with med eval/mgmt services

All approved billing codes for attending physicians during an authorized inpatient stay.

Once you utilize all sessions authorized by Cenpatico, you will need to complete an OTR form to request additional sessions.

Please fax your completed OTR to 866-694-3649. The Cenpatico clinical team will review and process your request once it is received. You will be notified of your new/updated authorization via fax. The usual turnaround time is 2-3 business days. If you have not gotten a response within this time frame please call customer service to request an update. Please keep all fax confirmation sheets.

You can find this on the Cenpatico website at www.cenpatico.com. You may also refer to the Cenpatico Provider Manual.

You can submit your claims electronically through a Clearinghouse:

Emdeon
Payer ID: 68051
800-845-6592

You can submit claims electronically through the Cenpatico website, www.cenpatico.com. Click on “login” and you will be prompted to register and obtain a
user name and password. If you submit claims via the website you will be able to see instantly whether a claim was accepted or not. You can also check claims status on the website.

You can mail your claims to:
Cenpatico Claims Processing
PO Box 6150
Farmington, MO 63640-3806 Cenpatico Ohio

You have 365 days from the Date of Service to submit your clean claim to Cenpatico for processing and reimbursement.

If you disagree with a claim denial call Claims Customer Service at 877-730-2117 for assistance. They will be able to tell you if the claim denial was appropriate and if you can appeal. You may appeal in writing within 90 days of the date of the denial on the Explanation of Payment to:

Cenpatico Appeals
PO Box 6000
Farmington, MO 63640-3809

How do I contact claims customer service?
Please contact 877-730-2117 to speak with Claims Customer Service.

Please refer to your reimbursement exhibit (fee schedule) in your agreement. Please ensure you follow all applicable authorization processes when billing these codes.

Submit a letter detailing your approval to change your Tax Identification Number (TIN) and include the new TIN effective date. A copy of your updated W9 must be attached. Please fax both to Provider Relations at 866-719-5436.
You may also mail Provider Relations at the following address:

Cenpatico
175 S 3rd
Street Ste 1200
Columbus OH 43215

Can I Bill a Member for Covered Services?
Per the CMS guidelines and your signed agreement with Cenpatico, Medicaid members may not be billed for covered services.

Managed Care Medicaid members do not have co-pays for behavioral health services.