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 
Attention Deficit Hyperactivity Disorder
Anxiety Disorders in Children and Adults
Depression in Children and Adolescents
Metabolic Status
Neuropsychological Testing
Pervasive Developmental Disorders
Psychological Testing
Substance Use Disorders in Adults
Behavioral Health Forms
BH/PMP Communication Form | MS Word 
Outpatient Treatment Request Form | MS Word NEW!
Psychological Testing Request Form | MS Word
Neuropsychological Testing Request Form | MS Word
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
Helpful Documents NEW!
Going Home Guide
Behavioral Health Guide
Quick Contact Sheet
Indiana Healthcare Programs Flow Sheet
IHCP Bulletins
Continuing Ed
SMART Goals
Using Rating Scales for Goal Writing
View Guide
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.
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