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Superbill Template Mental Health

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Subject Poster Date
[10233] - [#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: 1,469.00 KB, pages available: 127
- 61 graphics files
- 66 text files
- A4 paper format
- Last modified on November 16 2014
langstonswede 31-Oct
[17150] - [#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: 3,891.00 KB, pages available: 149
- 4 graphics files
- 145 text files
- Legal paper format
- Last modified on September 23 2014
ksechrist 02-Nov
[28633] - [#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: 1,852.00 KB, pages available: 33
- 13 graphics files
- 20 text files
- Legal paper format
- Last modified on October 31 2014
Brahmaji009 21-Nov
[13140] - [#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: 2,348.00 KB, pages available: 11
- 1 graphics files
- 10 text files
- Executive paper format
- Last modified on September 26 2014
E 04-Oct
[21637] - [#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: 1,259.00 KB, pages available: 46
- 2 graphics files
- 44 text files
- Legal paper format
- Last modified on November 04 2014
kcastill1 28-Oct
[14410] - [#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: 1,036.00 KB, pages available: 31
- 2 graphics files
- 29 text files
- Legal paper format
- Last modified on September 03 2014
AlanHardesty 01-Nov
[16814] - [#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: 1,096.00 KB, pages available: 128
- 49 graphics files
- 79 text files
- Legal paper format
- Last modified on November 04 2014
rua 30-Aug
[29285] - [#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: 1,573.00 KB, pages available: 138
- 4 graphics files
- 134 text files
- Executive paper format
- Last modified on October 14 2014
anitha 29-Aug
[16137] - [#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: 3,916.00 KB, pages available: 99
- 45 graphics files
- 54 text files
- Legal paper format
- Last modified on October 17 2014
de 04-Oct
[24989] - [#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: 504.00 KB, pages available: 80
- 32 graphics files
- 48 text files
- Executive paper format
- Last modified on September 18 2014
stevi 21-Sep
[17887] - [#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: 4,579.00 KB, pages available: 107
- 12 graphics files
- 95 text files
- Letter paper format
- Last modified on September 11 2014
jerrys 13-Oct
[29129] - [#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: 557.00 KB, pages available: 83
- 38 graphics files
- 45 text files
- Letter paper format
- Last modified on August 27 2014
pcwilliams21 24-Sep
[12403] - [#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: 1,980.00 KB, pages available: 99
- 40 graphics files
- 59 text files
- Letter paper format
- Last modified on August 28 2014
amethyst3640 07-Nov
[17294] - [#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: 4,106.00 KB, pages available: 102
- 38 graphics files
- 64 text files
- Letter paper format
- Last modified on October 11 2014
laxamana 24-Aug
[17427] - [#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: 4,499.00 KB, pages available: 143
- 6 graphics files
- 137 text files
- Executive paper format
- Last modified on September 12 2014
Jim 30-Sep
[24285] - [#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: 3,588.00 KB, pages available: 47
- 22 graphics files
- 25 text files
- Legal paper format
- Last modified on October 28 2014
HT2Cooper 29-Aug

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