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SUBMIT TO: Utilization Management Department 125158 Research Blvd., Suite 400 Austin, Texas 78759 PHONE 1.877.617.0390 FAX 1.866.279.1358 INTENSIVE OUTPATIENT×DAY TREATMENT FORM MENTAL HEALTH×CHEMICAL
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Start by locating the designated field or section for the provider name on the form or document you are working with.
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Once you have found the appropriate area, begin by typing or writing the full legal name of the provider.
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Double-check for any specific formatting instructions, such as capitalization or abbreviation guidelines, and follow them accordingly.
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If the provider has a specific title or designation that needs to be included (e.g., Dr., Prof., Jr.), make sure to include it before or after the name, as required.
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Take care to avoid any spelling or typographical errors when entering the provider's name, as accuracy is crucial for legal and professional purposes.
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After entering the provider's name, review all the other details on the form or document to ensure they are accurate and complete before proceeding further.

Who needs a provider name?

01
Healthcare providers: Doctors, nurses, therapists, pharmacists, or any other healthcare professionals typically require a provider name for identification and documentation purposes. It helps in maintaining records and ensuring appropriate accountability for the medical services provided.
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Insurance companies: Provider names are crucial for insurance companies to accurately process claims and reimburse healthcare providers for services rendered to policyholders. This information helps in confirming the legitimacy of the services and ensures proper payment.
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Patients or healthcare consumers: When seeking medical care, patients often need to know the name of their healthcare provider. It helps in building trust and establishing a professional relationship between the patient and the provider. Additionally, it allows patients to share their provider's information with other healthcare professionals involved in their care, thus facilitating effective communication and coordination.
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