Single Case Agreement (SCA) Authorization Request Attention: Colorado Member Services/CSA’sSingle Case Agreement • April 25th, 2017
Instructions: All fields are required. Submit one form for each member. Do not put more than one member per form. FAX only ONE member at a time. Do not send multiple members in one fax submission. Thank you.
SINGLE CASE AGREEMENTSingle Case Agreement • February 9th, 2003
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:
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.
SINGLE CASE AGREEMENTSingle Case Agreement • March 2nd, 2020
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 AGREEMENT FOR CONTINUITY OF CARE IN MENTAL HEALTH SERVICESSingle Case Agreement • April 13th, 2021 • California
SINGLE CASE AGREEMENT (SCA)Single Case Agreement • February 14th, 2017
If there is a member who needs a specific Medicaid or state funded service for a specific period of time and there is not a provider in the network available to provide the needed service a Single Case Agreement (SCA) can be requested.
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.
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.
Kaiser Single Case AgreementSingle Case Agreement • February 3rd, 2021
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Single Case Agreement Blue CrossSingle Case Agreement • September 1st, 2021
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