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Hoosier Healthwise Behavioral Health

Claims Dispute Forms

Please refer to the Hoosier Healthwise Forms web page for more information on Claims Dispute forms and processes.

Attention Behavioral Health Providers

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.

MDwise Behavioral Health Provider Directory

Behavioral Health Provider Search

Behavioral Health Guidelines pdf format

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 Adults

Metabolic Status
Neuropsychological Testing

Pervasive Developmental Disorders
Psychological Testing

Substance Use Disorders in Adults

Behavioral Health Forms

BH/PMP Communication Form pdf format | MS Word pdf format

Outpatient Treatment Request Form pdf format| MS Word NEW!

Psychological Testing Request Form pdf format | MS Word pdf format

Neuropsychological Testing Request Form pdf format | MS Word pdf format

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/
checklists_info.asp#CBCL

 

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:

http://www.cqaimh.org/pdf/tool_phq9.pdf

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