WebbC.Exchange of Information With Medical Delivery Systems ... 6.2 RE-REFERRALS ... Send all claims forms to: MHN . P.O. Box 14621 . Lexington, KY 40512-4621 . Send all credentialing documentation to: MHN Credentialing . … WebbHow to Reach Us. If you are a medical professional and have a question regarding the Medi-Cal Program, please call our Provider Information Line at 1-866-LA-CARE6 ( 1-866-522-2736 ). If you would like paper copies of any of the information available on the website, please contact us at 1-866-LA-CARE6 ( 1-866-522-2736 ).

Medical / Behavioral Care Coordination Referral Form

Webb16 dec. 2024 · Find helpful resources, plan materials, payment information and more. Enter a query above to search our website. WebbMHN and CA SMHS P&P MHN Medi-Cal ABA Referral Form Policies: 4/24/2024 12/17/18 - The following documentation supports the MCP’s efforts to correct this … brush ninja alternative

Prior Authorization, Notification, and Referral Guidelines

Webb• Service Order (from PhD, PsyD, MD, DO) for RBBHT or ABA • Autism Diagnosis and Supplemental Documentation o i.e., ADIR, ADOS, CARS, GARS • For Cardinal patients ONLY, a Cardinal Prior Approval Form is required to be completed by the referring physician. Reason for referral (Check all that apply): WebbElectronic Remittance Advice (ERA) Form Date: 04/13/2024 NEW PROCESS . EPSDT Clinical Sample Template Date: 02/2024 . EPSDT Supply Order Form Date: 03/22/2024. Eviction, Move In and Utilities Request Form Date: 11/25/2024 . External ACC Care Management Referral Form Date: 04/08/2024 . Exclusive Prescriber Program Referral … WebbMedi-Cal Primary Care Provider FAQs. Medi-Cal BHT Benefit As of July 1 2024, Medi-Cal plans are responsible for providing medically necessary Behavioral Health Therapy (BHT), ... recommendation for BHT or ABA services. Fax the referral form to (8 77) 321-1776. 3. brushkana creek alaska map