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SUBMIT TO: Utilization Management Department 125158 Research Blvd., Suite 400 Austin, Texas 78759 PHONE 1.877.687.1182 FAX 1.855.283.9094 INTENSIVE OUTPATIENT/DAY TREATMENT FORM MENTAL HEALTH/CHEMICAL
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What is the agencygroup name?
The agencygroup name refers to the name of the agency or group being referenced.
Who is required to file the agencygroup name?
The individuals or organizations specified in the regulations or guidelines are required to file the agencygroup name.
How to fill out the agencygroup name?
The agencygroup name must be filled out following the specific instructions provided by the governing authority.
What is the purpose of the agencygroup name?
The purpose of the agencygroup name is to correctly identify the agency or group in question.
What information must be reported on the agencygroup name?
The agencygroup name must include all relevant information as outlined in the filing requirements.
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