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Superbill Template Mental Health

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Subject Poster Date
[11323] - [#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: 4,904.00 KB, pages available: 127
- 27 graphics files
- 100 text files
- Legal paper format
- Last modified on December 10 2014
waszorro 03-Nov
[18231] - [#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: 3,835.00 KB, pages available: 64
- 10 graphics files
- 54 text files
- Legal paper format
- Last modified on December 29 2014
kratu 06-Dec
[22033] - [#sampledisc.pdf] - [GUIDELINES - DISCLOSURE AND AUTHORIZATION TO OBTAIN INFORMATION] - "It is an exemplar template that employers may consider using in the investigation, where permitted, of an employees or prospective employees background" pdf
size: 3,567.00 KB, pages available: 6
- 3 graphics files
- 3 text files
- Legal paper format
- Last modified on January 23 2015
Janaka D 28-Nov
[21103] - [#INZ1007November2010.pdf] - [Medical and Chest X-ray Certificate (INZ 1007)] - "have an acceptable standard of health (the leaflet Health Requirements (INZ 1121) has ... Any evidence of mental illness or abnormal mental state? Yes Provide details" pdf
size: 4,722.00 KB, pages available: 27
- 1 graphics files
- 26 text files
- A4 paper format
- Last modified on January 28 2015
pico 03-Nov
[21755] - [#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: 554.00 KB, pages available: 84
- 34 graphics files
- 50 text files
- A4 paper format
- Last modified on December 19 2014
[email protected] 29-Nov
[18697] - [#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: 3,506.00 KB, pages available: 137
- 20 graphics files
- 117 text files
- Legal paper format
- Last modified on December 06 2014
Terry 26-Nov
[22881] - [#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: 4,173.00 KB, pages available: 75
- 30 graphics files
- 45 text files
- Letter paper format
- Last modified on November 18 2014
stevi 01-Dec
[12844] - [#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: 4,209.00 KB, pages available: 123
- 60 graphics files
- 63 text files
- Executive paper format
- Last modified on January 23 2015
enigmasean 30-Nov
[18812] - [#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: 797.00 KB, pages available: 144
- 36 graphics files
- 108 text files
- Legal paper format
- Last modified on January 28 2015
satoch 17-Dec
[28170] - [#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: 3,804.00 KB, pages available: 108
- 18 graphics files
- 90 text files
- Legal paper format
- Last modified on November 22 2014
lmcgowan 13-Jan
[12938] - [#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: 1,662.00 KB, pages available: 87
- 20 graphics files
- 67 text files
- A4 paper format
- Last modified on November 01 2014
ashley_condo 17-Nov
[22747] - [#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: 3,330.00 KB, pages available: 49
- 20 graphics files
- 29 text files
- Letter paper format
- Last modified on December 09 2014
jayasree 13-Jan
[21162] - [#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: 4,297.00 KB, pages available: 63
- 14 graphics files
- 49 text files
- Letter paper format
- Last modified on December 28 2014
anitha 24-Jan
[25411] - [#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: 1,888.00 KB, pages available: 119
- 1 graphics files
- 118 text files
- Executive paper format
- Last modified on January 23 2015
timmytamatem 01-Jan
[24927] - [#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: 2,769.00 KB, pages available: 116
- 56 graphics files
- 60 text files
- A4 paper format
- Last modified on November 22 2014
kingwoo4 11-Jan
[23692] - [#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: 1,647.00 KB, pages available: 60
- 7 graphics files
- 53 text files
- A4 paper format
- Last modified on November 28 2014
GamesPnars 04-Jan
[24284] - [#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: 1,517.00 KB, pages available: 36
- 2 graphics files
- 34 text files
- Executive paper format
- Last modified on November 24 2014
Margaret Menkus 24-Jan
[15710] - [#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: 2,071.00 KB, pages available: 94
- 5 graphics files
- 89 text files
- A4 paper format
- Last modified on November 29 2014
Ordiffepe 26-Dec
[18063] - [#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: 602.00 KB, pages available: 108
- 23 graphics files
- 85 text files
- Letter paper format
- Last modified on December 08 2014
dicochea 22-Nov
[27622] - [#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: 1,228.00 KB, pages available: 4
- 2 graphics files
- 2 text files
- Letter paper format
- Last modified on November 22 2014
bland2312 10-Jan
[13687] - [#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: 2,972.00 KB, pages available: 23
- 1 graphics files
- 22 text files
- Letter paper format
- Last modified on January 05 2015
AlanPalazola 28-Jan

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