Appendix I: TAR FormsMedi-Cal Treatment Authorizations and Claims Processing, Appendices I1 Appendix...

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Medi-Cal Treatment Authorizations and Claims Processing, Appendices I1 Appendix I: TAR Forms TAR forms include: (Hospital) Extension-of-Stay (18-1) TAR for hospital stays; Long-term care (20-1) TAR for nursing home stays; Treatment Authorization Request (50-1) for medical procedures and pharmacy; and Discharge Planning Option (55-1) TAR for coordinated requests for a beneficiary being discharged.

Transcript of Appendix I: TAR FormsMedi-Cal Treatment Authorizations and Claims Processing, Appendices I1 Appendix...

  • Medi-Cal Treatment Authorizations and Claims Processing, Appendices I1

    Appendix I: TAR Forms

    TAR forms include: (Hospital) Extension-of-Stay (18-1) TAR for hospital stays;

    Long-term care (20-1) TAR for nursing home stays;

    Treatment Authorization Request (50-1) for medical procedures and pharmacy; and

    Discharge Planning Option (55-1) TAR for coordinated requests for a beneficiary being discharged.

  • Medi-Cal Treatment Authorizations and Claims Processing, Appendices I2

  • Medi-Cal Treatment Authorizations and Claims Processing, Appendices I3

  • Medi-Cal Treatment Authorizations and Claims Processing, Appendices I4

  • Medi-Cal Treatment Authorizations and Claims Processing, Appendices I5


APPENDIX A - SAMPLE FORMS

APPENDIX A - SAMPLE FORMS

Appendix 2: Food Safety Plan Forms

Appendix 2: Food Safety Plan Forms

APPENDIX A BLANK FORMS Appendix A.01.1 - Pre-Construction ...

APPENDIX A BLANK FORMS Appendix A.01.1 - Pre-Construction ...

APPENDIX A: HELICOPTER MANAGEMENT FORMS AND CHECKLISTS · APPENDIX A: HELICOPTER MANAGEMENT FORMS AND CHECKLISTS I. Introduction. This appendix provides standardized forms for the

APPENDIX A: HELICOPTER MANAGEMENT FORMS AND CHECKLISTS · APPENDIX A: HELICOPTER MANAGEMENT FORMS AND CHECKLISTS I. Introduction. This appendix provides standardized forms for the

APPENDIX E: SAMPLE FORMS - Bothell WA

APPENDIX E: SAMPLE FORMS - Bothell WA

APPENDIX A: FORMS - Supreme Court of Singapore22)-appendix-a---forms.pdf · APPENDIX A: FORMS Form Heading ... Specimen government medical certificate ... * This is to certify that

APPENDIX A: FORMS - Supreme Court of Singapore22)-appendix-a---forms.pdf · APPENDIX A: FORMS Form Heading ... Specimen government medical certificate ... * This is to certify that

LOCAL BANKRUPTCY RULES, FORMS AND APPENDIX

LOCAL BANKRUPTCY RULES, FORMS AND APPENDIX

Appendix, FOrms & Annexures · Appendix, Forms & Annexures Appendix A – Reporting Requirement The scope of work includes customized reports, workflows, user exits, enhancements,

Appendix, FOrms & Annexures · Appendix, Forms & Annexures Appendix A – Reporting Requirement The scope of work includes customized reports, workflows, user exits, enhancements,

Appendix E Selected State Forms - MEMA

Appendix E Selected State Forms - MEMA

Appendix A Forms - CDOT · Appendix A Forms Appendix A contains copies of the most common letters and forms (i.e., CDOT Forms, FHWA Forms) Local Agency personnel will use in designing,

Appendix A Forms - CDOT · Appendix A Forms Appendix A contains copies of the most common letters and forms (i.e., CDOT Forms, FHWA Forms) Local Agency personnel will use in designing,

Appendix D D-1 Field Collection Forms

Appendix D D-1 Field Collection Forms

APPENDIX D SAMPLE COMPLETED IICP REPORT FORMS

APPENDIX D SAMPLE COMPLETED IICP REPORT FORMS

APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS · APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS ... forms also provide a basis for training development and presentation.

APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS · APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS ... forms also provide a basis for training development and presentation.

Appendix B Measures and Self-Scoring Forms

Appendix B Measures and Self-Scoring Forms

APPENDIX A: FORMS - Supreme Court of Singapore22)-appendix-a---forms.pdf · A - 1 APPENDIX A: FORMS Form Heading Page No.

APPENDIX A: FORMS - Supreme Court of Singapore22)-appendix-a---forms.pdf · A - 1 APPENDIX A: FORMS Form Heading Page No.

Appendix D Resource Consent Application Forms

Appendix D Resource Consent Application Forms

APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS€¦ · APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS I. Introduction and Purpose. This appendix provides standardized

APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS€¦ · APPENDIX B: HELIBASE MANAGEMENT FORMS AND CHECKLISTS I. Introduction and Purpose. This appendix provides standardized

Appendix A Compliance Forms - newportbeachca.gov

Appendix A Compliance Forms - newportbeachca.gov

Appendix E: Sample CPC Intake Forms · 2018-05-31 · Appendix E: Sample CPC Intake Forms. Appendix E: Sample CPC Intake Forms. tender „ácare Pregnancy Consultation Services Patient

Appendix E: Sample CPC Intake Forms · 2018-05-31 · Appendix E: Sample CPC Intake Forms. Appendix E: Sample CPC Intake Forms. tender „ácare Pregnancy Consultation Services Patient

Appendix A — Recording forms - CIHI

Appendix A — Recording forms - CIHI