Forms

Provider Resources Forms

Manuals and Service Agreements


BHSI Provider Network

The BHSI Provider Network allows you to submit claim files, retrieve adjudication files and obtain approval codes for services.

Manuals and Service Agreements

Xeo Information

June 2019 BHSI Xeo Provider Meetings FAQ

Treatment Services Descriptions

BHSI Special Terms and Conditions

City of Philadelphia Contract Provisions
These Provisions are contained in the PMHCC Contract(s) with the City of Philadelphia. Where relevant, PMHCC Providers paid with funds provided pursuant to those Contracts must adhere to these same City of Philadelphia Contract Provisions.

City of Philadelphia 2018 Heat Safety Policy for Contractors

City of Philadelphia Whistleblower Protections Policy

DDAP PA-4

DDAP PA-6

Philadelphia Behavorial Health System Significant Incident Report

BHSI 5010 Professional Companion Guide

BHSI 5010 Professional 1A and 1B Services Companion Guide

BHSI 5010 Trading Partner Companion Guide

General Information

Claims

HIPAA 5010 Implementation - Valid until July 1st, 2019.

TA1 and 999 Acknowledgement FAQ - June 26, 2012.

Cost Reimbursement Enhanced Recovery

DBHIDS / OAS Budget Template
This includes Report Request, HDA311-2, HBA313B, Equipment Schedule and misc. item details.

May 2018 Cost Reimbursement Enhanced Recovery Services PowerPoint
Includes information about important websites, contact information about submitting invoices and services, setting up access to the Point of Contact Web Site