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Superbill Template Mental Health

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Subject Poster Date
[25990] - [#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: 700.00 KB, pages available: 85
- 13 graphics files
- 72 text files
- Letter paper format
- Last modified on November 24 2014
agerteple 10-Feb
[16852] - [#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: 2,168.00 KB, pages available: 56
- 28 graphics files
- 28 text files
- Letter paper format
- Last modified on January 11 2015
Georgi Stanishev 05-Dec
[26169] - [#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: 2,410.00 KB, pages available: 73
- 2 graphics files
- 71 text files
- A4 paper format
- Last modified on December 07 2014
sonex819 05-Feb
[10983] - [#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: 3,713.00 KB, pages available: 134
- 20 graphics files
- 114 text files
- A4 paper format
- Last modified on January 02 2015
selahmun 11-Dec
[23362] - [#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: 3,256.00 KB, pages available: 32
- 3 graphics files
- 29 text files
- A4 paper format
- Last modified on December 30 2014
onw 22-Nov
[16355] - [#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: 2,507.00 KB, pages available: 3
- 2 graphics files
- 1 text files
- Executive paper format
- Last modified on January 30 2015
puseneemurops 01-Dec
[29769] - [#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: 2,158.00 KB, pages available: 126
- 25 graphics files
- 101 text files
- Legal paper format
- Last modified on December 09 2014
edjiro_77 07-Feb
[11163] - [#pw_b134117.pdf] - [UTTIILLIIZZAATTIIOONN MMAANNAAGGEEMMEENNTT GGUUIIDDEELLIINNEE ...] - "Sample Authorization Notification Template -Commercial ... mental health RN services for a better evaluation of the members delusional thoughts." pdf
size: 4,602.00 KB, pages available: 110
- 28 graphics files
- 82 text files
- Legal paper format
- Last modified on December 20 2014
eng 02-Feb
[15008] - [#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: 2,452.00 KB, pages available: 55
- 18 graphics files
- 37 text files
- A4 paper format
- Last modified on February 15 2015
dtate 04-Feb
[12584] - [#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: 2,799.00 KB, pages available: 51
- 3 graphics files
- 48 text files
- Executive paper format
- Last modified on January 20 2015
mindytrapp 27-Dec
[27120] - [#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: 4,700.00 KB, pages available: 73
- 10 graphics files
- 63 text files
- Legal paper format
- Last modified on December 28 2014
homeplate 03-Dec
[12933] - [#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: 2,637.00 KB, pages available: 18
- 8 graphics files
- 10 text files
- Letter paper format
- Last modified on January 16 2015
davidsmithjrppp 23-Dec
[12267] - [#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: 790.00 KB, pages available: 111
- 5 graphics files
- 106 text files
- Legal paper format
- Last modified on February 16 2015
funmonkey543 15-Jan
[17811] - [#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: 3,977.00 KB, pages available: 116
- 56 graphics files
- 60 text files
- Legal paper format
- Last modified on December 20 2014
lilone97 06-Dec
[24161] - [#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: 2,604.00 KB, pages available: 143
- 38 graphics files
- 105 text files
- Executive paper format
- Last modified on January 03 2015
acrosson 23-Dec
[15647] - [#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: 4,314.00 KB, pages available: 114
- 3 graphics files
- 111 text files
- Letter paper format
- Last modified on November 30 2014
Assangepat 08-Dec
[10504] - [#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: 2,128.00 KB, pages available: 58
- 1 graphics files
- 57 text files
- A4 paper format
- Last modified on January 02 2015
satoch 14-Dec
[28123] - [#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: 1,494.00 KB, pages available: 106
- 19 graphics files
- 87 text files
- Letter paper format
- Last modified on November 30 2014
im_xyz 09-Dec
[12187] - [#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: 949.00 KB, pages available: 104
- 38 graphics files
- 66 text files
- A4 paper format
- Last modified on January 09 2015
Terry 06-Dec
[16822] - [#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: 3,389.00 KB, pages available: 45
- 12 graphics files
- 33 text files
- Legal paper format
- Last modified on December 26 2014
dawn 19-Dec

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