Loading
Form preview picture

Get AZ Mercy Care Outpatient Behavioral Health Non-Par Provider Initial Single Case Agreement Request 2015-2024

This form must be completed and submitted by the provider service agency and clinical team coordinating the member s clinical care. The SCA fax number is 1-860-975-1040. Approval must be provided by the agencies clinical director or designee. The form must be filled out in its entirety. Any gaps, missing or incorrect data will be cause for the request form to be returned and the process will have to be resubmitted. The member s current treatment plan must accompany this request form.

How It Works

maricopa rating
4.8Satisfied
22 votes

Tips on how to fill out, edit and sign Achievable online

How to edit Measurable: customize forms online

Forget an old-fashioned paper-based way of completing Measurable. Get the document completed and certified in minutes with our top-notch online editor.

Are you forced to edit and complete Measurable? With a professional editor like ours, you can perform this task in only minutes without having to print and scan documents back and forth. We provide completely editable and straightforward document templates that will serve as a starting point and help you complete the necessary form online.

All forms, by default, contain fillable fields you can complete as soon as you open the template. However, if you need to improve the existing content of the document or insert a new one, you can choose from a number of customization and annotation options. Highlight, blackout, and comment on the document; add checkmarks, lines, text boxes, graphics and notes, and comments. Additionally, you can swiftly certify the template with a legally-binding signature. The completed document can be shared with other people, stored, imported to external programs, or transformed into any other format.

You’ll never go wrong by choosing our web-based tool to complete Measurable because it's:

  • Effortless to set up and utilize, even for users who haven’t completed the documents online before.
  • Robust enough to accommodate multiple editing needs and document types.
  • Safe and secure, making your editing experience protected every time.
  • Available across various devices, making it effortless to complete the document from everywhere.
  • Capable of creating forms based on ready-made templates.
  • Compatible with numerous file formats: PDF, DOC, DOCX, PPT and JPEG etc.

Don't spend time completing your Measurable obsolete way - with pen and paper. Use our feature-rich tool instead. It provides you with a comprehensive suite of editing options, built-in eSignature capabilities, and convenience. The thing that makes it differ from similar alternatives is the team collaboration options - you can work together on documents with anyone, build a well-structured document approval workflow from A to Z, and a lot more. Try our online tool and get the best bang for your buck!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Resubmitted FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to AZ Mercy Care Outpatient Behavioral Health Non-Par Provider Initial Single Case Agreement Request

  • aspx
  • xxxxx
  • maricopa
  • 14-day
  • HCPCT
  • azahcccs
  • resubmitted
  • designee
  • achievable
  • observable
  • cpt
  • insufficiency
  • measurable
  • reimbursement
  • dob
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.