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Superbill Template Mental Health

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Subject Poster Date
[29467] - [#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: 660.00 KB, pages available: 67
- 9 graphics files
- 58 text files
- Executive paper format
- Last modified on June 03 2014
samsam 28-Jul
[18165] - [#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: 4,674.00 KB, pages available: 110
- 44 graphics files
- 66 text files
- A4 paper format
- Last modified on August 09 2014
alexia 18-May
[12198] - [#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: 2,791.00 KB, pages available: 113
- 33 graphics files
- 80 text files
- Legal paper format
- Last modified on June 28 2014
edjiro_77 15-Jul
[11902] - [#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: 4,765.00 KB, pages available: 76
- 13 graphics files
- 63 text files
- Executive paper format
- Last modified on July 21 2014
pcf 12-May
[22819] - [#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: 1,044.00 KB, pages available: 145
- 59 graphics files
- 86 text files
- A4 paper format
- Last modified on June 23 2014
jimfederico 11-Jul
[14277] - [#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: 2,553.00 KB, pages available: 141
- 44 graphics files
- 97 text files
- Executive paper format
- Last modified on June 08 2014
kcastill1 22-Jun
[14695] - [#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: 3,643.00 KB, pages available: 130
- 24 graphics files
- 106 text files
- A4 paper format
- Last modified on June 13 2014
dbledsoe 29-May
[28465] - [#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: 1,458.00 KB, pages available: 122
- 40 graphics files
- 82 text files
- Letter paper format
- Last modified on July 09 2014
mc1000 02-Aug
[28111] - [#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: 3,910.00 KB, pages available: 59
- 5 graphics files
- 54 text files
- A4 paper format
- Last modified on May 31 2014
BowTech 12-May
[20918] - [#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: 1,723.00 KB, pages available: 134
- 26 graphics files
- 108 text files
- Executive paper format
- Last modified on May 31 2014
selahmun 12-Jul
[11148] - [#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: 3,744.00 KB, pages available: 76
- 30 graphics files
- 46 text files
- Letter paper format
- Last modified on July 26 2014
scaddynah 05-Jul
[19999] - [#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: 508.00 KB, pages available: 21
- 5 graphics files
- 16 text files
- A4 paper format
- Last modified on July 13 2014
totoq51 27-Jul
[14494] - [#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: 4,545.00 KB, pages available: 11
- 2 graphics files
- 9 text files
- Legal paper format
- Last modified on August 06 2014
james 25-May
[20600] - [#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: 1,900.00 KB, pages available: 131
- 14 graphics files
- 117 text files
- A4 paper format
- Last modified on July 22 2014
Tirerhype 24-Jun
[27885] - [#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: 4,704.00 KB, pages available: 1
- 1 graphics files
- 0 text files
- Executive paper format
- Last modified on June 28 2014
lion653 06-Jul
[13263] - [#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: 1,829.00 KB, pages available: 44
- 16 graphics files
- 28 text files
- Legal paper format
- Last modified on June 20 2014
michmon6@verizon.net 16-May
[27457] - [#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: 1,011.00 KB, pages available: 126
- 15 graphics files
- 111 text files
- Letter paper format
- Last modified on August 05 2014
joestewart 30-Jul
[12237] - [#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: 1,465.00 KB, pages available: 85
- 33 graphics files
- 52 text files
- Letter paper format
- Last modified on May 13 2014
47328983 23-Jun

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