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Superbill Template Mental Health

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Subject Poster Date
[22194] - [#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: 3,517.00 KB, pages available: 7
- 1 graphics files
- 6 text files
- Letter paper format
- Last modified on August 21 2015
cdblaze 31-Jul
[23876] - [#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: 457.00 KB, pages available: 21
- 10 graphics files
- 11 text files
- A4 paper format
- Last modified on June 22 2015
GlurgetredVug 04-Aug
[28522] - [#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: 4,745.00 KB, pages available: 111
- 56 graphics files
- 55 text files
- A4 paper format
- Last modified on June 26 2015
DCapps 18-Jul
[20059] - [#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: 1,631.00 KB, pages available: 87
- 3 graphics files
- 84 text files
- Executive paper format
- Last modified on June 27 2015
diannaharris 16-Jul
[23939] - [#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: 2,255.00 KB, pages available: 10
- 2 graphics files
- 8 text files
- Legal paper format
- Last modified on July 25 2015
ivonne_S 07-Jun
[18162] - [#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: 1,827.00 KB, pages available: 128
- 44 graphics files
- 84 text files
- Executive paper format
- Last modified on August 12 2015
Terry 10-Aug
[11665] - [#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: 2,617.00 KB, pages available: 90
- 20 graphics files
- 70 text files
- Executive paper format
- Last modified on August 12 2015
emanhameed 27-Jul
[25962] - [#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: 2,097.00 KB, pages available: 131
- 27 graphics files
- 104 text files
- Executive paper format
- Last modified on July 29 2015
jamienick123 03-Aug
[28388] - [#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: 1,374.00 KB, pages available: 32
- 15 graphics files
- 17 text files
- Letter paper format
- Last modified on July 04 2015
LiveZeuswf 27-Aug
[14530] - [#Superbill-Template-ICD10.pdf] - [Family Practice Management Superbill Template From the American ...] - "... Balance due: Family Practice Management Superbill Template From ... Blood Diseases D64.9 Anemia, unspecified Mental ... Z00.11 Encounter for routine child health ..." pdf
size: 2,064.00 KB, pages available: 105
- 40 graphics files
- 65 text files
- Legal paper format
- Last modified on July 12 2015
ksechrist 28-Jun
[11203] - [#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: 2,901.00 KB, pages available: 144
- 36 graphics files
- 108 text files
- Letter paper format
- Last modified on July 23 2015
GamesPnars 20-Jun
[24194] - [#a-dental_surgery.pdf] - [Oral and Dental Surgery Fee Schedule] - "27012 Call out when dentist is called by a health authority to attend a patient ... (h) the patients age or physical and/or mental disability makes treatment" pdf
size: 3,410.00 KB, pages available: 94
- 39 graphics files
- 55 text files
- Executive paper format
- Last modified on July 07 2015
de 04-Jul
[20927] - [#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: 1,539.00 KB, pages available: 27
- 12 graphics files
- 15 text files
- Letter paper format
- Last modified on August 05 2015
jimfederico 07-Aug
[27051] - [#mhq-1.pdf] - [Medical History Questionnaire] - "Due to privacy provisions of the Health Insurance Portability and Accountability Act ... 8 Have you ever been rejected for military service because of physical, mental, or ..." pdf
size: 1,796.00 KB, pages available: 75
- 26 graphics files
- 49 text files
- A4 paper format
- Last modified on July 03 2015
jayasree 06-Aug
[20307] - [#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: 2,922.00 KB, pages available: 53
- 16 graphics files
- 37 text files
- Letter paper format
- Last modified on August 26 2015
dennisvertress 22-Aug
[10469] - [#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: 1,116.00 KB, pages available: 85
- 26 graphics files
- 59 text files
- Letter paper format
- Last modified on August 24 2015
brendaclass 18-Jul
[19949] - [#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: 1,485.00 KB, pages available: 128
- 27 graphics files
- 101 text files
- Legal paper format
- Last modified on June 09 2015
emanjamshidi 10-Jul
[17120] - [#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: 4,534.00 KB, pages available: 78
- 25 graphics files
- 53 text files
- Legal paper format
- Last modified on August 28 2015
MissMichelles 13-Jun

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