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Beacon Health Strategies LLC 90 Day Waiver Request Form I. Demographic Information Provider Name Beacon Provider ID Member Name Member ID Contact Person Telephone II. PROVIDER RETROACTIVELY ELIGIBLE FOR REIMBURSEMENT MEMBER RETROACTIVELY ENROLLED THIRD PARTY COVERAGE COPY OF EOB REQUIRED PLEASE ATTACH I am requesting a waiver of the 90 day timely filing deadline for the above reason s. I hereby certify that the above claim for services is true and correct. I further understand and agree...
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Step 1: Gather all necessary information such as personal details, medical history, and insurance information.
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Step 2: Visit the website of Beacon Health Strategies LLC.
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Step 3: Locate the 'Forms' section on the website.
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Step 4: Download the 'Beacon Health Strategies LLC Enrollment Form'.
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Beacon Health Strategies LLC is a managed behavioral health organization that offers behavioral health management services to individuals and families.
Beacon Health Strategies LLC is required to file by the owners or authorized representatives of the business.
To fill out Beacon Health Strategies LLC, you will need to provide information about the company's financials, owners, operations, and any other relevant details.
The purpose of Beacon Health Strategies LLC is to provide managed behavioral health services to help individuals and families improve their mental health and well-being.
Information such as financial statements, ownership details, operational information, and any other relevant data must be reported on Beacon Health Strategies LLC.
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