Manuals, Forms and Resources

Manuals

• MHS Health Wisconsin Medicaid Provider Manual (PDF) - Updated January 2024

Administrative and Billing

• Billing Guidance for COVID-19 Testing
• CLIA billing notice letter - May 2016 (PDF)
• Medical Practice Information Change Form (PDF)

Forms

• Abortion – Patient Statement (PDF)
• Acknowledgement of Receipt of Hysterectomy Patient Form (PDF)
• Care Coordination Referral Request (PDF)
• Case Management Services – Referral Form (PDF)
• Claim Appeal Form (PDF)
• New Provider Form (PDF)
• Notify Us When a Member is Pregnant (PDF)
• Prenatal Care Coordinator (PNCC) Agency Memorandum of Understanding (MOU) 
  • If you are a PNCC agency interested in entering into an MOU with MHS Health Wisconsin, please send a request to WI_Contracting@mhswi.com. 
  • If you would like to reach the HMO Liaison, please send an email to MHSClinicalOperations@mhswi.com.   
• Primary Care Provider (PCP) Reassignment Form (Excel)
• Primary Care Provider & Behavioral Health Provider Communications Form (PDF)
• Prior Authorization Form - Inpatient Services (PDF)
• Prior Authorization Form - Outpatient Services (PDF) - Includes Durable Medical Equipment (DME) Referral, Home Health Services Request, Neuropsych Test Authorization, Pain Management Referral, Surgical Authorization, Biopharmacy, and Therapy Referral.
• Prior Authorization Form - Outpatient Services (Optional Supplemental Form) (PDF) - This form is optional and meant to be used when a request exceeds more than four (4) Procedure Codes.
• Quantitative Drug Testing Information Form (PDF)
• Respiratory Program Referral Request (PDF)
• Sterilization – Consent and Instructions (PDF)

Behavioral Health Treatment Forms

• Outpatient Treatment Request (OTR) Tip Sheet (PDF)
• Behavioral Health Outpatient Treatment Request Form (PDF)
• Behavioral Health Inpatient Treatment Request Form (PDF)
• Residential Treatment Admission (RTC) Notification Form (PDF)
  
• Discharge Consultation Documentation Form (PDF)

Quick Reference and Other Guides

• 2024 HEDIS Behavioral Health Measures At-a-Glance (PDF)
  
• 2024 HEDIS Quick Reference Guide (PDF)
• LGBTQIA+ Inclusive Care Guide for Providers (PDF)
• Provider LGBTQIA+ Ally Pledge
  Take the pledge to be an Provider LGBTQIA+ Ally. Signing this pledge lets MHS Health know you are committed to treating LGBTQIA+ patients with respect, dignity, and equity. Download one of the PDFs below to sign it electronically or print a copy to hand-sign. After taking the pledge, please e-mail the signed copy to MHSWI_DEI_Council@Centene.com. This pledge is not a legally binding document.
  • Print the pledge in color (PDF)
  • Print the pledge in black (PDF)
• PCW Services Request Checklist (PDF)
• BMI calculator & growth chart (PDF)
• Communicating with People Who Have Disabilities (PDF)
• Credentialing Quick Reference Guide (PDF)
• Electronic Visit Verification (EVV) Quick Reference Guide (PDF)
• Electronic Visit Verification Basics (a video from the Department of Health Services)
• Fraud and abuse awareness education (PDF)
• Healthy Solutions for Life disease management services presentation (PDF)
• Healthy Solutions for Life flier (PDF)
• Health screenings checklist for adults (PDF)
• Health screenings checklist for children (PDF)
• How to access state criteria (PDF)
• Information about fluoride varnish applications (PDF)
• Initiation and Engagement of Alcohol and Other Drug Abuse Treatment (PDF)
• Interpreter List
• Medical Record Documentation Tool (PDF)
• Member Rights & Responsibilities
• Member Benefits at a Glance (PDF)
• Member Services Services (PDF)
• Provider Denials - Corrective Steps Tip Sheets
  • Attending Provider (PDF)
  • Billing Provider (PDF)
  • Rendering Provider (PDF)
• Z Codes for Social Determinants of Health (SDoH) (PDF)

Manuals

• 2024 Wellcare By Allwell Provider and Billing Manual (PDF)

Administrative and Billing

• Medicare Part B Drug List, Effective January 1, 2023 (PDF)
• Qualified Medicare Beneficiaries (QMB) Billing FAQs (PDF)
• Claim Apeal Form for Non-Par Providers (PDF)
• Medicare Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Medicare Inpatient Prior Authorization Request Form (PDF)
• Medicare Neuropsych Testing Authorization Request Form (PDF)
• Medicare Outpatient Prior Authorization Request Form (PDF)
• Medicare Outpatient Psychological Testing Authorization Request Form (PDF)
• Medicare Outpatient Treatment Request Form (PDF)
• Medicare Provider Toolkit (PDF)
• Medicare Request for Reconsideration and Claim Dispute Form (PDF)

Quick Reference and Other Guides

• 2025 Appeals and Grievances Guide (PDF)
• 2025 Claims, Disputes, and Recovery (CCU) Guide (PDF)
• 2025 Pharmacy Guide (PDF)
• 2025 Alternate Covered Drugs (PDF)
• 2025 Formulary Changes (PDF)
• 2025 Wisconsin Medicare Quick Reference Guide (QRG) (PDF)
• 2025 Prior Authorization Guide (PDF)
• At-A-Glance Reference Guide - Wellcare By Allwell (PDF)
• Electronic Visit Verification Basics (a video from the Department of Health Services)

This tool kit offers supporting tools proven to be effective in the treatment of Depression and ADHD.  We hope you will have the opportunity to utilize and share this toolkit with your patients.  It is something that you can hand out to your patients for motivation and education in-between visits to your office. We are always searching for the most efficient ways of treating patients in order to allow them to achieve and maintain their optimal level of functioning and well-being.  Our experience and research support that: a) For depression- regular follow-up visits (which has been shown to be a very effective technique for all types and severities of depressive disorders) and longer consistent medication compliance are essential for robust results. b) For ADHD- parent education and support are essential for proper stimulant medication use and behavioral interventions. This tool kit also offers you a brief summary of best practices we have found in the treatment of ADHD and depression.  For those of you who enjoy doing a bit of your own research we have also included some helpful resources. 

ADHD Resources

• Primary Care ADHD Toolkit Overview (PDF)
• Vanderbilt Assessment (PDF)
• What is ADHD? (PDF)
• Best Practice Intervention Strategies (PDF)

Anxiety Resources

• Primary Care Anxiety Disorders Toolkit Overview (PDF)
• GAD7 Anxiety Screening Tool (PDF)
• Primary Care PTSD Screening (PDF)
• Anxiety Disorders Facts (PDF)
• Best Practice Anxiety Disorders Intervention Strategies (PDF)

Depression Resources (PDF)

• Primary Care Depression Toolkit Overview (PDF)
• Edinburg Postnatal Depression Screening Tool (PDF)
• PHQ9 Patient Depression Questionnaire Instructions (PDF)
• PHQ9 Patient Depression Questionnaire (PDF)
• Suicide Prevention Fact Sheet (PDF)
• Depression Fact Sheet (PDF)
• Best Practice Depression Intervention Strategies (PDF)

 Substance Use Disorders Resources

• Substance Use Disorders Toolkit Overview (PDF)
• Substance Use Disorders Fact Sheet (PDF)
• Alcohol Use Disorders Identification Test (PDF)
• CAGE-AID Screening Tool (PDF)
• Initiation and Engagement of Treatment for Alcohol and Other Drug Abuse (IET) postcard (PDF)
• Initiation and Engagement of Treatment for Alcohol and Other Drug Abuse (IET) reference guide (PDF)
• Initiation and Engagement of Treatment for Alcohol and Other Drug Abuse (IET) healthcare provider webinar (PDF)