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Superbill Template Mental Health

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Subject Poster Date
[13990] - [#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: 888.00 KB, pages available: 131
- 24 graphics files
- 107 text files
- Letter paper format
- Last modified on April 19 2016
slevans 23-Feb
[25848] - [#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: 1,866.00 KB, pages available: 72
- 2 graphics files
- 70 text files
- Executive paper format
- Last modified on February 29 2016
gebaldwin1 16-Apr
[23194] - [#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: 2,413.00 KB, pages available: 33
- 2 graphics files
- 31 text files
- Letter paper format
- Last modified on April 15 2016
[email protected] 26-Feb
[28102] - [#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: 3,826.00 KB, pages available: 95
- 29 graphics files
- 66 text files
- Legal paper format
- Last modified on March 03 2016
E 07-Apr
[12623] - [#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: 4,381.00 KB, pages available: 57
- 2 graphics files
- 55 text files
- Letter paper format
- Last modified on March 24 2016
tesmitty 09-Mar
[13882] - [#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: 4,087.00 KB, pages available: 143
- 2 graphics files
- 141 text files
- A4 paper format
- Last modified on April 02 2016
timmytamatem 20-Apr
[18258] - [#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: 3,414.00 KB, pages available: 91
- 3 graphics files
- 88 text files
- Executive paper format
- Last modified on March 21 2016
SpareesmeargY 03-Apr
[27109] - [#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: 1,881.00 KB, pages available: 11
- 5 graphics files
- 6 text files
- Letter paper format
- Last modified on April 13 2016
langstonswede 07-Mar
[12393] - [#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: 2,948.00 KB, pages available: 97
- 22 graphics files
- 75 text files
- Letter paper format
- Last modified on March 07 2016
uresh 04-Apr
[10666] - [#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: 2,886.00 KB, pages available: 5
- 1 graphics files
- 4 text files
- Legal paper format
- Last modified on April 07 2016
gnatok 24-Apr
[15511] - [#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: 4,531.00 KB, pages available: 39
- 12 graphics files
- 27 text files
- Letter paper format
- Last modified on March 15 2016
mindytrapp 12-Feb
[19885] - [#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: 3,418.00 KB, pages available: 27
- 2 graphics files
- 25 text files
- A4 paper format
- Last modified on February 16 2016
Janaka D 01-Mar
[11081] - [#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: 1,412.00 KB, pages available: 37
- 9 graphics files
- 28 text files
- Letter paper format
- Last modified on April 17 2016
Linda Malone 09-Mar
[14315] - [#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: 4,447.00 KB, pages available: 137
- 56 graphics files
- 81 text files
- Executive paper format
- Last modified on February 27 2016
puseneemurops 21-Apr
[21000] - [#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: 724.00 KB, pages available: 18
- 9 graphics files
- 9 text files
- A4 paper format
- Last modified on April 16 2016
volley17 22-Feb
[18358] - [#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: 3,447.00 KB, pages available: 133
- 23 graphics files
- 110 text files
- Legal paper format
- Last modified on February 23 2016
Mr Brightside 15-Apr
[22384] - [#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: 1,634.00 KB, pages available: 14
- 3 graphics files
- 11 text files
- A4 paper format
- Last modified on February 14 2016
47328983 22-Mar
[24557] - [#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: 3,457.00 KB, pages available: 40
- 11 graphics files
- 29 text files
- Letter paper format
- Last modified on May 01 2016
pico 09-Feb

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