Transcription of Specialty Substance Use Disorder (SUD) System ...
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Specialty Substance Use Disorder (SUD) System ...
Specialty Substance Use Disorder (SUD) System Documentation Examples 1. Service Request Form 2. Progress Notes 3. Treatment Plan 4. Discharge / Transfer Form 5. Miscellaneous Note Options Revision Service Request Form 2. SERVICE REQUEST FORM. All services delivered in managed care environments require a determination of eligibility for services, and certain services require preauthorization or authorization by the managed care entity, in this case SAPC. This process of reviewing services is known as utilization management. Utilization management ensures that delivered services are medically necessary and appropriate. The Service Request Form is an essential part of utilization management and is the provider's opportunity to demonstrate a patient is eligible for services (Part A of the Service Request Form) and request preauthorization or authorization for a certain service (Part B of the Service Request Form).
Examples are provided for outpatient, residential, inpatient, and Opioid Treatment ... (Last, First, Middle) 4. Date of Birth: (MM/DD/YY) 5. Medi-Cal or MHLA Number: 6. Address: 7. Phone Number: ☐Okay to Leave a Message? ... ☐ ASAM level 3.3 Clinically Managed High Intensity (Population Specific) ☐ASAM level 3.5Clinically Managed High ...
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