Healthy Indiana Plan (HIP) Behavioral Health Services
Claims Dispute Forms
Please refer to the Healthy Indiana Plan Forms web page for more information on Claims Dispute forms and processes.
Authorization of Behavioral Health Services
Providers serving Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP) members should continue to use the Behavioral Health Outpatient Treatment Request Form (OTR) for authorization of behavioral health services. The Universal Prior Authorization form is only applicable to behavioral health when requesting services for the Care Select Program.
Behavioral Health Guidelines 
Attention Deficit Hyperactivity Disorder
Anxiety Disorders in Children and Adults
Bipolar Disorder in Adults
Depression in Children and Adolescents
Developmental Testing
Eating Disorders
Major Depression in AdultsMetabolic Status
Neuropsychological Testing
Pervasive Developmental Disorders
Psychological Testing
Substance Use Disorders in Adults
Behavioral Health Forms
Provider Services 
Psychological Testing Request Form
Outpatient Treatment Request Form NEW!
Coordination of Care Form
Neuropsychological Testing Form
Rating Scale Resources
Spanish and English versions of the Vanderbilt ADHD rating scales
http://childrenshospital.vanderbilt.org/uploads/documents/med-ped_VADPRS_Quest(1).pdf
Offers an overview of many rating scales and gives links to where they can be ordered or downloaded for free.http://www2.massgeneral.org/schoolpsychiatry/
schoolpsychiatry_screeningtools.asp
Pediatric Symptoms Checklist
http://psc.partners.org/psc_order.htm
Downloadable versions of several rating scales
http://www.centerforpediatrics.com/
For Care Managers, PHQ9 Depression Screening:
Helpful Documents NEW!
Going Home Guide
Behavioral Health Quick Reference Guide
Quick Contact Sheet
Healthcare Programs Flow Sheet
IHCP Bulletins
Continuing Ed
OTR Instruction Guide
The MDwise OTR guide provides instructions on the vital information to include on the OTR form in order to receive prior authorization.
View PowerPoint 
Questions?
If you have questions, please contact MDwise Provider Relations at 1.877.822.7196 or (local) 822.7196.
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