Forms

Provider Resources Forms

DDAP 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.

BHSI has made significant changes in operating procedures. Click here to see a copy of the letter sent to providers the week of 2/22/2016. A copy of the instructions of using the new forms can be found here.

Manuals and Service Agreements

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 Trading Partner Companion Guide

Behavioral Health Special Initiative Provider Manuals

Authorization/Approval Process

Claims Submissions

General Information

Provider Hotline - information about claims and website support.

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
NEW! Includes information about important websites, contact information about submitting invoices and services, setting up access to the Point of Contact Web Site