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Superbill Template Mental Health

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Subject Poster Date
[20248] - [#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: 2,651.00 KB, pages available: 6
- 1 graphics files
- 5 text files
- A4 paper format
- Last modified on July 01 2014
jamienick123 21-Jul
[18230] - [#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: 2,130.00 KB, pages available: 3
- 1 graphics files
- 2 text files
- Executive paper format
- Last modified on June 21 2014
james 26-Apr
[14028] - [#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: 4,591.00 KB, pages available: 149
- 17 graphics files
- 132 text files
- A4 paper format
- Last modified on June 24 2014
mguertler721 01-Jul
[20360] - [#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: 2,254.00 KB, pages available: 99
- 21 graphics files
- 78 text files
- A4 paper format
- Last modified on July 17 2014
dachosen21 03-May
[20598] - [#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: 1,960.00 KB, pages available: 7
- 2 graphics files
- 5 text files
- Legal paper format
- Last modified on April 27 2014
lopphile 26-Jun
[15744] - [#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: 972.00 KB, pages available: 107
- 52 graphics files
- 55 text files
- Executive paper format
- Last modified on May 19 2014
pico 23-Jun
[27793] - [#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: 3,851.00 KB, pages available: 131
- 13 graphics files
- 118 text files
- Executive paper format
- Last modified on May 13 2014
username 29-May
[25500] - [#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: 1,617.00 KB, pages available: 62
- 21 graphics files
- 41 text files
- Executive paper format
- Last modified on June 02 2014
ahmedezaz 06-Jul
[19162] - [#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: 3,932.00 KB, pages available: 91
- 18 graphics files
- 73 text files
- Legal paper format
- Last modified on June 13 2014
lilacs66 04-Jul
[12714] - [#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: 2,326.00 KB, pages available: 98
- 43 graphics files
- 55 text files
- Letter paper format
- Last modified on June 29 2014
edjiro_77 25-May
[28452] - [#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: 1,575.00 KB, pages available: 100
- 14 graphics files
- 86 text files
- Executive paper format
- Last modified on July 17 2014
47328983 15-May
[20978] - [#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: 1,422.00 KB, pages available: 36
- 7 graphics files
- 29 text files
- Executive paper format
- Last modified on May 18 2014
awargo-secor 27-Apr
[23649] - [#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: 671.00 KB, pages available: 28
- 10 graphics files
- 18 text files
- Letter paper format
- Last modified on May 10 2014
jgroves 21-Jul
[29365] - [#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: 481.00 KB, pages available: 119
- 49 graphics files
- 70 text files
- A4 paper format
- Last modified on July 09 2014
dudgns6985 01-Jul
[17070] - [#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: 1,423.00 KB, pages available: 89
- 34 graphics files
- 55 text files
- Legal paper format
- Last modified on June 15 2014
jyudiejyud 28-Jun
[19532] - [#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: 1,923.00 KB, pages available: 60
- 21 graphics files
- 39 text files
- Executive paper format
- Last modified on July 01 2014
rschwertley 04-May
[24261] - [#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: 2,872.00 KB, pages available: 30
- 11 graphics files
- 19 text files
- Executive paper format
- Last modified on July 18 2014
nmack 01-May
[18339] - [#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: 1,758.00 KB, pages available: 57
- 25 graphics files
- 32 text files
- Letter paper format
- Last modified on June 06 2014
michmon6@verizon.net 28-Jun
[29608] - [#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: 2,731.00 KB, pages available: 111
- 5 graphics files
- 106 text files
- Legal paper format
- Last modified on July 16 2014
agerteple 06-Jul
[23274] - [#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: 2,247.00 KB, pages available: 121
- 58 graphics files
- 63 text files
- Letter paper format
- Last modified on May 11 2014
samsam 26-May
[20951] - [#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: 3,585.00 KB, pages available: 98
- 23 graphics files
- 75 text files
- Legal paper format
- Last modified on April 29 2014
20-May

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