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Get and Sign CUT0124 Outpatient Pre Treatment Authorization Program OPAP Initial Request 2010 Form

Get and Sign CUT0124 Outpatient Pre Treatment Authorization Program OPAP Initial Request 2010 Form

Use a CUT0124 Outpatient Pre Treatment Authorization Program OPAP Initial Request 2010 template to make your document workflow more streamlined.

800-842-5975 2. Additional HMO Specific Requirements n For CareFirst BlueChoice Inc. products including BlueChoice HMO Opt-Out and Opt-Out Plus a PCP may also be required to submit a written referral to a therapist for the first three 3 visits to include 1 evaluation and 2 treatments. Patient s Employment B. Motor Vehicle Accident C. Other Accident Date of onset / / Number of Visit s Requested Fax Number Date s of Service From / / To / / PART III DISCLAIMER The above approval is based on the...
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