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Superbill Template Mental Health

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Subject Poster Date
[29540] - [#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: 1,661.00 KB, pages available: 57
- 21 graphics files
- 36 text files
- Letter paper format
- Last modified on January 18 2016
wsaffo 22-Nov
[11042] - [#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: 3,560.00 KB, pages available: 108
- 43 graphics files
- 65 text files
- Executive paper format
- Last modified on November 11 2015
chidi nwosu 11-Nov
[29204] - [#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: 2,272.00 KB, pages available: 26
- 6 graphics files
- 20 text files
- Letter paper format
- Last modified on January 24 2016
Brahmaji009 20-Nov
[13324] - [#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: 1,996.00 KB, pages available: 115
- 23 graphics files
- 92 text files
- A4 paper format
- Last modified on November 08 2015
jgroves 18-Dec
[24169] - [#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: 2,039.00 KB, pages available: 96
- 30 graphics files
- 66 text files
- Executive paper format
- Last modified on January 13 2016
anitha 28-Jan
[21755] - [#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: 1,828.00 KB, pages available: 32
- 11 graphics files
- 21 text files
- Legal paper format
- Last modified on November 04 2015
sonex819 11-Dec
[18013] - [#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: 1,351.00 KB, pages available: 9
- 5 graphics files
- 4 text files
- Letter paper format
- Last modified on November 20 2015
sunny7775 03-Nov
[12310] - [#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: 4,919.00 KB, pages available: 22
- 6 graphics files
- 16 text files
- A4 paper format
- Last modified on December 23 2015
Lumpkine 23-Jan
[28157] - [#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: 1,740.00 KB, pages available: 19
- 9 graphics files
- 10 text files
- Executive paper format
- Last modified on November 23 2015
telchar 02-Nov
[26270] - [#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: 1,947.00 KB, pages available: 124
- 10 graphics files
- 114 text files
- Executive paper format
- Last modified on November 10 2015
judylaylo 29-Nov
[15194] - [#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: 3,773.00 KB, pages available: 47
- 11 graphics files
- 36 text files
- Legal paper format
- Last modified on January 26 2016
aliciapc 25-Jan
[12519] - [#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: 2,978.00 KB, pages available: 124
- 39 graphics files
- 85 text files
- Letter paper format
- Last modified on November 28 2015
concha 12-Dec
[26543] - [#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: 4,475.00 KB, pages available: 1
- 1 graphics files
- 0 text files
- Letter paper format
- Last modified on December 16 2015
amethyst3640 08-Dec
[12542] - [#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: 834.00 KB, pages available: 37
- 4 graphics files
- 33 text files
- Executive paper format
- Last modified on November 16 2015
pcf 03-Jan
[21786] - [#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: 4,248.00 KB, pages available: 34
- 14 graphics files
- 20 text files
- Executive paper format
- Last modified on October 31 2015
mindytrapp 25-Nov
[11922] - [#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: 4,369.00 KB, pages available: 130
- 27 graphics files
- 103 text files
- Executive paper format
- Last modified on January 15 2016
DCapps 22-Dec
[22524] - [#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: 3,697.00 KB, pages available: 87
- 42 graphics files
- 45 text files
- Legal paper format
- Last modified on December 27 2015
lavanya 15-Dec
[19836] - [#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: 3,216.00 KB, pages available: 39
- 13 graphics files
- 26 text files
- A4 paper format
- Last modified on November 06 2015
hope 08-Jan
[21014] - [#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: 3,492.00 KB, pages available: 49
- 14 graphics files
- 35 text files
- Executive paper format
- Last modified on December 28 2015
htucker32327 01-Nov

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