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Superbill Template Mental Health

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Subject Poster Date
[10603] - [#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: 3,675.00 KB, pages available: 41
- 1 graphics files
- 40 text files
- Legal paper format
- Last modified on March 15 2015
alexia 29-Jan
[24976] - [#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: 3,851.00 KB, pages available: 128
- 2 graphics files
- 126 text files
- A4 paper format
- Last modified on January 24 2015
chabre 05-Feb
[25181] - [#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: 4,501.00 KB, pages available: 73
- 12 graphics files
- 61 text files
- Legal paper format
- Last modified on February 01 2015
dereje 24-Jan
[10732] - [#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: 4,014.00 KB, pages available: 60
- 24 graphics files
- 36 text files
- Letter paper format
- Last modified on February 09 2015
waszorro 19-Feb
[12675] - [#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: 2,003.00 KB, pages available: 85
- 21 graphics files
- 64 text files
- A4 paper format
- Last modified on March 01 2015
joestewart 23-Mar
[27314] - [#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: 1,026.00 KB, pages available: 73
- 12 graphics files
- 61 text files
- Letter paper format
- Last modified on January 23 2015
concha 02-Apr
[29986] - [#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: 4,994.00 KB, pages available: 84
- 17 graphics files
- 67 text files
- Executive paper format
- Last modified on April 03 2015
zumajuumyop 22-Mar
[12694] - [#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: 1,580.00 KB, pages available: 13
- 6 graphics files
- 7 text files
- Legal paper format
- Last modified on February 14 2015
pcf 05-Feb
[17730] - [#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: 630.00 KB, pages available: 72
- 13 graphics files
- 59 text files
- A4 paper format
- Last modified on February 11 2015
railcarmover 15-Jan
[21845] - [#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: 4,033.00 KB, pages available: 33
- 5 graphics files
- 28 text files
- Executive paper format
- Last modified on February 16 2015
childhere 14-Mar
[21796] - [#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: 2,309.00 KB, pages available: 65
- 26 graphics files
- 39 text files
- Legal paper format
- Last modified on March 22 2015
lagr19 15-Mar
[29140] - [#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: 2,491.00 KB, pages available: 125
- 35 graphics files
- 90 text files
- Executive paper format
- Last modified on February 12 2015
smochecef 01-Feb
[27724] - [#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: 1,162.00 KB, pages available: 56
- 23 graphics files
- 33 text files
- A4 paper format
- Last modified on March 17 2015
jtaltree 25-Jan
[25780] - [#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: 4,316.00 KB, pages available: 40
- 9 graphics files
- 31 text files
- A4 paper format
- Last modified on April 01 2015
kingwoo4 19-Mar
[12597] - [#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: 3,954.00 KB, pages available: 43
- 10 graphics files
- 33 text files
- Letter paper format
- Last modified on February 15 2015
james 15-Feb
[14292] - [#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: 4,834.00 KB, pages available: 38
- 3 graphics files
- 35 text files
- Executive paper format
- Last modified on February 26 2015
pico 28-Jan
[26462] - [#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: 780.00 KB, pages available: 86
- 17 graphics files
- 69 text files
- A4 paper format
- Last modified on February 20 2015
tleatherbarrow 03-Feb

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