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Superbill Template Mental Health

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Subject Poster Date
[20282] - [#Sample_superbill_icd10.pdf] - [PLEASE RETURN THIS FORM TO RECEPTIONIST] - "This sample superbill was converted to ICD-10-CM by the American Health Information Ma nagement Association ... R41.82 Mental Status Change . G43.9 Migraine . M79.1 Muscle ..." pdf
size: 1,195.00 KB, pages available: 48
- 10 graphics files
- 38 text files
- Legal paper format
- Last modified on May 31 2015
toufikbourenane 03-Jul
[17387] - [#mm_0096_coveragepositioncriteria_physical_therapy.pdf] - [C IGNA M EDICAL C OVERAGE P OLICY] - "The following Coverage Policy applies to all health ... delays, autism, and mental retardation and/or for that ... http://www.apta.org/AM/Template.cfm?Section=Policies_and ..." pdf
size: 3,952.00 KB, pages available: 24
- 3 graphics files
- 21 text files
- A4 paper format
- Last modified on July 01 2015
Margaret Menkus 25-Apr
[20151] - [#EHRBHVisitEntry.pdf] - [Behavioral Health (BH) Visit Entry] - " 14 MENTAL HEALTH 48 MEDICAL SOCIAL WORK ... or Superbill tab.Activity Time component is often found ... VueCentric BH User Template TIU Note BH ..." pdf
size: 2,820.00 KB, pages available: 102
- 2 graphics files
- 100 text files
- Executive paper format
- Last modified on May 16 2015
mrjohnmueller 05-Jul
[12365] - [#pw_003800.pdf] - [Claim Form - 1 of 2 Section 1: MeMber inforMation] - "Anthem Blue Cross and Blue Shield or their agents any and all information, including complete medical history records and mental health and substance abuse records, for" pdf
size: 4,512.00 KB, pages available: 111
- 36 graphics files
- 75 text files
- Letter paper format
- Last modified on June 24 2015
Deetuetriaw 29-Jun
[10824] - [#Handbook_Audiology_Clinic.doc] - [ Access Doc] - "The incident report template is located in the ... co-payments from those patients with health insurance coverage. This superbill ... stigma, to include family history of mental ..." doc
size: 4,763.00 KB, pages available: 72
- 11 graphics files
- 61 text files
- A4 paper format
- Last modified on May 25 2015
acrosson 22-Apr
[15076] - [#Physical%20and%20Occupational%20Therapy%20Guide.pdf] - [PT/OT Billing Guide] - "Providers are also defined as public health agencies with agreements only to furnish outpatient therapy services, or community mental health centers with agreements only ..." pdf
size: 4,889.00 KB, pages available: 15
- 2 graphics files
- 13 text files
- A4 paper format
- Last modified on June 08 2015
stephen lang 12-Jun
[23180] - [#Superbill_Sample_MH.doc] - [Superbill] - "Superbill Superbill is a term for a billing format for the mental health clinician who wants to handle billing in a simplified manner." doc
size: 4,633.00 KB, pages available: 21
- 3 graphics files
- 18 text files
- Letter paper format
- Last modified on June 15 2015
onw 29-May
[17563] - [#newpatientpacketweb07.09.pdf] - [New Patient Form] - "This includes your insurance and billing records but not counseling notes of a mental health professional, information prepared by or for our attorneys to defend TTUHSC ..." pdf
size: 3,052.00 KB, pages available: 128
- 59 graphics files
- 69 text files
- Letter paper format
- Last modified on June 11 2015
jcurry41 15-May
[27199] - [#prepare-that-claim.pdf] - [Prepare that Claim] - "This document also includes new printable checklists and logs in which physician practices can record important information about claims and health insurers; thus ..." pdf
size: 1,446.00 KB, pages available: 12
- 2 graphics files
- 10 text files
- Executive paper format
- Last modified on April 20 2015
Rodyordedge 17-Jun
[27500] - [#ChristyHall2010.pdf] - [Christina M. Hall, PsyD, P.C.] - "While in New Orleans, I provided individual, family, and group mental health services to ... like Dr. Hall to provide me with a receipt for services (also known as a Superbill ..." pdf
size: 2,091.00 KB, pages available: 2
- 1 graphics files
- 1 text files
- A4 paper format
- Last modified on May 19 2015
uriahub 26-Apr
[20261] - [#Chart_Audit.pdf] - [Chart Audit and Review Form] - "Chart Audit and Review Form Chart Number/Name: Date: Comments: Overall Appearance of Chart Good / Fair / Poor Chart Organization Good / Fair / Poor Chart Contents Y ..." pdf
size: 3,895.00 KB, pages available: 40
- 7 graphics files
- 33 text files
- Legal paper format
- Last modified on June 20 2015
gpguidry 04-Jun
[17236] - [#UBO_User_Guide_12_06_2007.doc] - [ACCOUNTS RECEIVABLE] - "Mental Health has team conferences that do not meet ... into MSA and TPOCS from the supplied dental superbill. ... customized medical equipment/supply pick-list template ..." doc
size: 3,282.00 KB, pages available: 97
- 26 graphics files
- 71 text files
- Letter paper format
- Last modified on May 08 2015
kcastill1 07-Jun
[13187] - [#rmbgde_TempLetter_FacPriorApproval_01_us.doc] - [SAMPLE LETTER OF MEDICAL NECESSITY] - "Template Letter for Medical Necessity. Up to date as of October 8, 2008. Please note that information and the needs of payers change frequently." doc
size: 635.00 KB, pages available: 110
- 19 graphics files
- 91 text files
- Letter paper format
- Last modified on June 21 2015
jgroves 31-May
[12413] - [#AWV%20Non%20Programs.pdf] - [SCAN Health Plan] - "... or are underway for the individual any mental health ... number of HEDIS/5-Star measures, into the template ... If you choose a code from the superbill or encounter ..." pdf
size: 3,788.00 KB, pages available: 100
- 31 graphics files
- 69 text files
- A4 paper format
- Last modified on April 23 2015
nmack 24-Apr
[22474] - [#MassageTherapy_IntakeForm.pdf] - [Massage Therapy Intake Form] - "I affirm that I have stated all my known medical conditions and shall take it upon myself to keep my Massage Therapist updated on my physical/mental health." pdf
size: 3,537.00 KB, pages available: 144
- 52 graphics files
- 92 text files
- Letter paper format
- Last modified on May 02 2015
trichard5 01-Jun
[29629] - [#Health%20Care%20Access%20Services.pdf] - [WRIGHT COUNTY HUMAN SERVICES AGENCY HEALTH CARE ACCESS SERVICES] - "physical or mental health condition (such as a broken limb, etc.) submit a Letter of Medical Necessity to your primary healthcare provider, confirming this" pdf
size: 3,847.00 KB, pages available: 59
- 18 graphics files
- 41 text files
- A4 paper format
- Last modified on April 17 2015
markmuir 29-May
[21829] - [#Patient%20Encounter%20Form.doc] - [Patient Encounter Form] - "Corvallis Family Medicine, P.C. Date: 2400 NW Kings Blvd. 541-757-2400 phone. Corvallis, OR 97330 541-752-0931 fax" doc
size: 1,884.00 KB, pages available: 22
- 9 graphics files
- 13 text files
- Letter paper format
- Last modified on April 22 2015
zqiongyue 11-Apr
[23644] - [#ACG_2008_Vendor_Short_Form_Survey.doc] - [Draft 2007 RFI Questions] - "... such as reviewing all components on the superbill so ... advanced reporting or building of a new alert template. ... Dept of Mental Health Other titles: Draft 2007 RFI Questions" doc
size: 3,586.00 KB, pages available: 89
- 13 graphics files
- 76 text files
- Executive paper format
- Last modified on May 24 2015
Viet 26-Apr
[23135] - [#EPSDT_Instructions.pdf] - [EPSDT ENCOUNTER FORM] - "screening, or for a mental health referral in the appropriate boxes below the preventive visit diagnosis code. Submit codes on claim. 11. Additional ICD-9 codes: These ..." pdf
size: 2,093.00 KB, pages available: 14
- 2 graphics files
- 12 text files
- Letter paper format
- Last modified on April 19 2015
tleatherbarrow 12-Jun
[10345] - [#Superbill-Template-ICD9.pdf] - [Family Practice Management Superbill Template From the American ...] - "... Flu, 3 y + 90658 Home health certification G0180 Lesion ... Balance due: Family Practice Management Superbill Template From ... Mental Disorders 300.00 Anxiety state, unspec. 314.00 ..." pdf
size: 1,655.00 KB, pages available: 20
- 10 graphics files
- 10 text files
- Executive paper format
- Last modified on June 29 2015
chris_about 09-Apr

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