Provider Information
Psychiatric Residential Treatment Facility Transition Waiver
All DMHA certified CA-PRTF Demonstration Grant service providers (as of September 30, 2012) automatically became a MFP-PRTF service provider (on October 1, 2012), without any additional documentation requirements, as long as the following criteria were met:
- Provider was current and up-to-date with all certification requirements;
- Provider was current and up-to-date with all DMHA required trainings;
- Provider was considered in “good standing” (Good standing is defined as having no open or pending investigations, incidents or complaints through FSSA or Department of Child Services); and
- Provider status was Active, and not Suspended, Terminated or Closed.
As needed, to support this limited waiver program, additional child service agencies and providers in areas of need may continue to be recruited to become PRTF Transition Waiver service providers. Prospective service providers must complete the Provider Application and Certification processes, as defined in this section and in the PRTF Transition Waiver Provider Manual.
Provider Certification
- Provider Demographic Instruction Sheet
- Provider Demographic Application
- Wraparound Facilitator Service Provider Instruction Sheet
- Wraparound Facilitator Service Provider Application
- Wraparound Technician Provider Certification Form
- Habilitation Services Provider Instruction Sheet
- Habilitation Services Provider Application
- Consultative and Clinical Therapy Provider Certification Form
- Training & Support for the Unpaid Caregiver Services Provider Instruction Sheet
- Training & Support for the Unpaid Caregiver Services Provider Application
- Respite Services Provider Instruction Sheet
- Respite Services Provider Application
- Non-Medical Provider Certification Form
- Provider Agreement
- CPS Background Check Request Form
- Background History Check Information
- CPS Background Screen FAQ's
- Inkless Registration Instructions
Provider Recertification
- Provider Renewal of Approval Checklist
Wraparound Practitioner Certification (WPC) Program
- General Information (Information to be posted)
- Certification & Training Program (Information to be posted)
- WPC Forms (Information to be posted)
Provider Training
All providers are required to complete training based upon the type of service DMHA has authorized the provider to deliver. Refer to the Provider Manual for additional information about new provider and recertification training requirements. The provider manual is the DMHA Home and Community-Based Services Waiver Provider Manual located on the Indiana Medicaid website.
Child and Adolescent Needs and Strengths Training and Certification
For information about the CANS training and registration, click here. You can also receive additional information by contacting our CANS training by clicking here.
Billing for Services
- MFP-PRTF Services HCPCS Billing Codes
- HP Billing and Claims Support
- IHCP Information (Medicaid Provider Information)
Miscellaneous Provider Forms and Information