Common Contracts
1 similar Single Case Agreement (Sca) contracts
Medicare Advantage single case agreement formSingle Case Agreement (Sca) • January 4th, 2021
Instructions: Providers must first obtain a medical necessity approval for services, prior to requesting a Single Case Agreement (SCA). Please fill out all applicable sections on both pages completely and legibly before faxing or mailing the form to the number or address listed below. Attach any additional documentation necessary for processing the SCA. Information contained in this form is Protected Health Information under HIPAA.
