Provider Tools

Includes information and patient resources on ADHD, Anxiety, Depression and Substance Use Disorder.

ADHD Toolkit

• ADHD Factsheet
• What is ADHD Brochure

Anxiety Toolkit

• Anxiety Disorders Brochure
• GAD7 Anxiety Screening tool
• Anxiety Fact Sheet
• Med Guide Anxiety
• PC-PTSD

Substance Use Disorder Toolkit

• Substance Use Brochure
• SUD Toolkit Overview
• Fact Sheet Alcohol and Other Drugs
• AUDIT Screener for Alcohol
• CAGE-AID Screening Tool

Depression Toolkit

• Edinburg Postnatal Screening Tool
• Depression Fact Sheet
• Med Guide Antidepressants
• PHQ9 Depression Screening Tool
• Depression Toolkit Overview
• PHQ9 Instructions

Handbook and Manuals

Provider Manual

Cultural Competency Plan

Clinical

• Clinical Practice Guidelines 2014-2015
• Practice Parameters
• Incident Report Form
• SMART Goals – Fact Sheet

Medical Necessity Criteria

*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.

Frequently Asked Questions (FAQs)

Contact Information

State and Health Plan Contacts

• CHIRP Immunization Registry
• Hoosier Healthwise
• Indiana Family and Social Services Administration
• Indiana Medicaid
• Indiana State Department of Health
• Managed Health Services (MHS)
• Medicaid Select
• Vaccines for Children (VFC) Program

Quick Reference Guides (QRGs)

Forms

For Allwell provider forms click here: https://www.mhsindiana.com/allwellproviders.html

Administrative & Claims

• Chart Audit Form
• Medical Record Release Form
• Provider Complaint Form
• Provider Change Form
• Facility Change Form
• W-9 (must accompany Provider Change Form)
• SCA Request Forms are no longer available online. Please contact clinical services at (877) 647-4848 for information about SCA.

Interpreter Request Form

Behavioral/Physical Health Form

Outpatient Treatment Request (OTR) Form

• Outpatient Treatment Request (OTR) Form
• Outpatient Treatment Request (OTR) Tips Sheet
• Outpatient Treatment Request (OTR) – Training Presentation
• Intensive Outpatient/Day Treatment Form Mental Health/Chemical Dependency
• Applied Behavioral Analysis Treatment OTR

Psychological Testing Authorization Request Form

• Outpatient Psychological Testing Authorization
• Inpatient Psychological Testing Authorization Form
• Indiana Neuropsych Testing Form

School Based Counseling Forms

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

Discharge Consultation Documentation

Newsletters