Provider Network

Please contact Dawn Woodard, Clinical Services Manager at 608-250-6634 ext. 104 with any questions and if you would like a Word version of the following documents e-mailed to you. All but the noted document are in a PDF format.

General Provider Information

Provider Manual

Provider Application

Provider Background Check

Provider Change/Addition/Deletion

Covered Services

Certification Guide

Enrollee Rights

Provider W-9 Form

Credentialing And Recredentialing Policy

Recredentialing Form

Contract Termination Policy

Grievance And Appeal Procedure

Provider Audit Policy

Out-of-Network Providers

Critical Incident Policy

Critical Incident Report Form

Caregiver Background Check Policy

Prior Authorization Information

Prior authorization form--Word format
*If you experience any difficulties opening this form, save the document elsewhere prior to opening by ''right clicking'' on the above link and saving to a different location. This can then be e-mailed back to Community Partnerships when complete.

Prior authorization form

Parent Aide/Mentoring Information

Parent Aide/ Mentor Protocol

Parent Aide/Mentor billing Form

Verification of Training Certificate

Clinical Practice Guidelines

CCF has adopted the following clinical practice guidelines to assist providers in the assessment and treatment of disorders commonly occurring among CCF enrollees:

Prior to the adoption, each guideline is reviewed by a multi-disciplinary panel that includes a Board certified psychiatrist, psychologist and master’s level providers, CCF Clinical Supervisors and Coordinators, and a parent representative.

We welcome your feedback on our adopted clinical practice guidelines. All suggestions and recommendations will be taken into consideration in our next review. You may submit your comments to the CCF Clinical Services Manager.

Clinical practice guidelines which have been adopted by CCF and are owned by the American Academy of Child and Adolescent Psychiatry are available on our website at www.community-partnerships.org. If you do not have internet access, you can request a hard copy of the guidelines from the Clinical Services Manager at 608-250-6634 ext.104.