Single Case Agreement Form Out of Network ProviderSingle Case Agreement • August 9th, 2018
IMPORTANT: To prevent delays in processing time, please provide completed documentation specific to this request. Also follow the Instructions for New Facilities found on the County Website http://www.countyofsb.org/behavioral-wellness/asset.c/4521. Failure to do so may delay billing.
IN THE MATTER OF EXECUTING A SINGLE-CASE ) AGREEMENT NO. SCA 22 SCRBH & RII (5) BETWEEN ) SPOKANE COUNTY COMMUNITY SERVICES, HOUSING, ) AND COMMUNITY DEVELOPMENT DEPARTMENT ) (CSHCD), SPOKANE COUNTY REGIONAL BEHAVIORAL ) HEALTH DIVISION (SCRBH), AND...Single-Case Agreement • September 14th, 2022
WHEREAS, the Board of County Commissioners of Spokane County, Washington, pursuant to Revised Code of Washington, Section 36.32.120(6), has the care of county property and the management of County funds and business; and
SINGLE CASE AGREEMENTSingle Case Agreement • February 9th, 2003
Single Case Agreements:Single Case Agreement • January 6th, 2021
Many more experienced therapists do not participate in insurance panels. For those seeking help from a therapist with a specialization or specific level of experience, this can make it more difficult to use insurance benefits. Because of this, it may be helpful to determine whether your insurance may pay for services using a Single Case Agreement.
SINGLE CASE AGREEMENTSingle Case Agreement • October 23rd, 2022 • New York
SINGLE CASE AGREEMENT WITHSingle Case Agreement • February 3rd, 2021
This SINGLE CASE AGREEMENT is made and entered into by and between the County of Cook (“County”), an Illinois body politic and corporate, by and through its operating unit, Cook County Health and Hospitals System doing business as Cook County Health and (“Out-of-Network Provider”).
ContractSingle Case Agreement • October 16th, 2003
This Single Case Agreement becomes part of your Voluntary Group Producer Agreement, and is governed by the terms of that Agreement except as may be amended herein:
ContractSingle Case Agreement • October 16th, 2003
This Single Case Agreement becomes part of your Worksite Specialist or Producer Agreement, and is governed by the terms of that Agreement except as may be amended herein:
Single Case AgreementSingle Case Agreement • August 28th, 2019 • Vermont
Producer is licensed to do business in the State of Vermont as an insurance Producer representing (hereinafter referred to as "Account" or "Client"), a Vermont employer for the purpose of obtaining health benefits for Client’s employees.
Hereinafter called the Company) SINGLE CASE AGREEMENTSingle Case Agreement • December 12th, 2002
*This should be the percentage of premium that the agent/general agent will receive as commission. Do not enter “100%” in this space.
SINGLE CASE AGREEMENTSingle Case Agreement • March 2nd, 2020
Cigna Single Case Agreement FormSingle Case Agreement • September 4th, 2021
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MOLINA HEALTHCARE OF FLORIDA, INC. SINGLE CASE AGREEMENTSingle Case Agreement • January 29th, 2019 • Florida
In consideration of the promises and representations stated, the Parties agree as set forth in this Single Case Agreement (“Agreement”). The Authorized Representative acknowledges, warrants, and represents that the Authorized Representative has the authority and authorization to act on behalf of its Party.
Single Case AgreementsSingle Case Agreement • March 29th, 2019
A Single Case Agreement is a one-time negotiation between a physician or provider group and an insurance company of which you are not currently in contract. These out of the network providers may negotiate higher dollar claims in order to receive payment
This template letter to your health insurer may be used to formally request a single case agreement.Single Case Agreement • May 6th, 2024
Describe what you have done to overcome the obstacles, for example, calls with customer service reps, filing formal complaint
SCA Rendering Provider FormSingle Case Agreement • December 4th, 2017
Arrangement is for a Single Case Agreement for only the individual for whom it was authorized and for only those services authorized, and there are no in-network providers whose qualifications or specialties match those required to adequately treat the individual.
OVERVIEWSingle Case Agreement • October 18th, 2023
T o request a Single Case Agreement (SCA) OR a SCA Extension, complete all information below. Send completed forms to deliverables@nsbhaso.org. Once received, North Sound Behavioral Health Administrative Services Organization (North Sound BH-ASO) will initiate a Letter of Agreement for signature. Please note, incomplete forms may result in a delay in processing.
GREATER COLUMBIA BEHAVIORAL HEALTH, LLC BH-ASOSingle Case Agreement • April 16th, 2021 • Washington
Single Case Agreements (SCA) with Greater Columbia Behavioral Health BH-ASO are for all Non-Medicaid Individuals who reside within the Greater Columbia Behavioral Health BH-ASO Regional Service Area (RSA) that are detained on an Involuntary Treatment Act (ITA).
SINGLE CASE AGREEMENTSingle Case Agreement • April 22nd, 2019
Are there any actions or investigations against you/ any owner or QP in your organization, privileges, billing organizations or sanctions? ☐ Yes ☐ No (if yes please describe) Click here to enter text.
31A-22-658 Health care provider behavioral health treatment -- Single case agreement.Single Case Agreement • May 3rd, 2023
Kaiser Single Case AgreementSingle Case Agreement • February 3rd, 2021
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SINGLE CASE AGREEMENTS FOR BEHAVIORAL HEALTH SERVICESSingle Case Agreement • December 11th, 2023
On occasion, Cenpatico grants exceptions, called Single Case Agreements, that allow individuals whose benefit plans do not include out-of-network benefits to see a non-contracted professional utilizing their in-network benefit.
SINGLE CASE AGREEMENTSingle Case Agreement • May 30th, 2003
The Writing Agent must complete this Agreement and submit it, along with the new business information, to the General Agent. The General Agent will complete the Agreement and forward it to Special Insurance Services. No Agent will be paid commission until he/she is appointed by the underwriting carrier.
Single Case Agreement Blue CrossSingle Case Agreement • September 1st, 2021
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