Behavioral Health

• Behavioral Health Join Our Network
• Blank W-9 Form (PDF)
• Collaborating Clinician Statement (PDF)
• Disclosure of Ownership Form (PDF)
• Facility Application (PDF)
• Group Attestation Form (PDF)
• Provider Change Form (PDF)
• Provider Specialty Profile (PDF)

Magnolia Health

• Claim Appeal Form (PDF)
• CMS 1500 Claim Form Instructions (PDF)
• Discharge Consultation Documentation (PDF)
• Member Appeals Authorized Representative Form (PDF)
• PaySpan (PDF)
• Provider Complaint-Grievance Form (PDF)
• Taxonomy Code Billing Requirement (PDF)

MississippiCAN

Outpatient Treatment Request (OTR) Form

• Outpatient Treatment Request Form (PDF)
• Outpatient Treatment Request Tip Sheet (PDF)

Inpatient Treatment Request  (ITR) Form

• Inpatient Treatment Request Form (PDF)

Injectable Antipsychotics Request for Prior Authorization

• Injectable Antipsychotics Authorization Form (PDF)

Discharge Consultation Documentation

• Discharge Consultation Documentation (PDF)

Wellcare

Outpatient Treatment Request Form

• Outpatient Treatment Request Form (PDF)

Electroconvulsive Therapy (ECT) Authorization Request Form

Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)

Neuropsychological Testing Authorization Request Form 

• Neuropsychological Testing Authorization Request Form (PDF)

Teladoc  

We all have our struggles.

Finding support to focus on your emotional health is important.

Now you can use web and mobile tools to help you get better and stay mentally strong.

Teladoc is safe and secure – just for you. It offers personalized resources to improve your mood. Learning to use  Teladoc’s tools can help you overcome the challenges you face.

• Preferred Drug List (PDL) (PDF)

Magnolia Health

• Autism Spectrum Disorders Treatment Form (PDF)
• Discharge Consultation Documentation (PDF)
• Electroconvulsive Therapy (ECT) (PDF)
• Injectable Antipsychotics Authorization Form (PDF)
• Inpatient Psychological Testing Authorization (PDF)
• Intensive Outpatient/Day Treatment Form (PDF)
• Outpatient Psychological Testing Authorization (PDF)
• Outpatient Treatment Request Form (PDF)
• Outpatient Treatment Request Tip Sheet (PDF)

• Attention Deficit Hyperactivity Disorder: Tips for Families (PDF)
• Depression (PDF)
• Managing Schizhophrenia Symptoms (PDF)
• Substance Abuse Disorder (PDF)

Magnolia Health offers trainings for both behavioral health and physical health providers in our network at no cost. Our team provides mostly clinical, provider-focused education on topics that are geared towards improving member outcomes. The majority of our clinical trainings also offer behavioral health continuing education units also at no cost to the attendee. Trainings are completed via live/virtual instructor led webinars.

How to sign up for trainings:

1. View the lists of all upcoming trainings: 
   • Magnolia Health Behavioral Health Training list
2. Select the training date and time that you would like to attend
3. Enter the required information and click “Register”
4. You will receive a confirmation email with a link and instructions for joining the webinar. NOTE: Please check your junk folder if you do not receive the confirmation email.
5. When you join the webinar, the call-in telephone number and an attendee passcode will be displayed.

 Training topics include but are not limited to:

• Inpatient Clinical Documentation:  MNC, Discharge Planning and Readmission for Providers
• Outpatient Clinical Documentation:  MNC, SMART Goals for Treatment Planning
• Screening, Brief Intervention and Referral to Treatment (SBIRT):  An Implementation Guide for Health Care Providers
• Behavioral Health Screening Tools
• Cultural Competency/Cultural Humility
• Clinical Topics in Behavioral Health
  • Overview of Mental Illness
  • Anxiety Related Disorders
  • Bipolar Related Disorders
  • Depressive Disorders
  • PTSD Disorders
  • Schizophrenia and Other Psychotic Disorders
• Substance Use Disorders Topics
  • SUD Overview
  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Nicotine
  • Stimulants
  • Non-Substance:  Gambling

For training requests and/or more information, please contact our Clinical Provider Training Department at: BH_training@centene.com.

• Attention Deficit Hyperactivity Disorder: Tips for Families (PDF)

• Depression (PDF)

• Managing Schizophrenia Symptoms (PDF)

• Substance Abuse Disorder (PDF)