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NC MH/DD/SAS Health Plan
NC Innovations Waiver
Instructions for the Cardinal Innovations Healthcare Level of Care Determination
All LoCs for authorization are submitted in Provider Direct per the
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How to fill out nc mhddsas health plan
How to fill out nc mhddsas health plan
01
To fill out the NC MHDDSAS health plan, follow these steps:
02
Obtain a copy of the health plan form from the NC MHDDSAS website or your healthcare provider.
03
Read the instructions provided with the form carefully to understand the required information.
04
Start by providing your personal details such as name, address, contact information, and demographic information.
05
Next, fill out the sections related to your current health condition or medical history. Provide accurate and detailed information about any existing diagnoses, medications, or treatments.
06
If applicable, include information about any mental health or substance abuse history.
07
Answer all the questions related to eligibility criteria or specific services you are seeking from the NC MHDDSAS.
08
Attach any supporting documents or medical reports that may be required to support your health plan.
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Review the completed form for accuracy and completeness.
10
Sign and date the form before submitting it to the appropriate entity as instructed.
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Retain a copy of the filled-out form for your records.
Who needs nc mhddsas health plan?
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The NC MHDDSAS health plan is necessary for individuals who require mental health, developmental disabilities, and substance abuse services in North Carolina.
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Anyone who has a diagnosed condition or believes they may have a mental health, developmental disability, or substance abuse issue can benefit from having a health plan.
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This may include individuals seeking treatment, therapy, counseling, or other specialized services related to mental health, developmental disabilities, or substance abuse.
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Both children and adults can be in need of an NC MHDDSAS health plan, depending on their specific circumstances and healthcare requirements.
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What is nc mhddsas health plan?
The nc mhddsas health plan is a comprehensive health plan designed for individuals with mental health, developmental disabilities, and substance abuse needs.
Who is required to file nc mhddsas health plan?
Providers, facilities, and agencies involved in the treatment and care of individuals with mental health, developmental disabilities, and substance abuse needs are required to file the nc mhddsas health plan.
How to fill out nc mhddsas health plan?
The nc mhddsas health plan can be filled out online through the designated portal provided by the North Carolina Department of Health and Human Services.
What is the purpose of nc mhddsas health plan?
The purpose of the nc mhddsas health plan is to ensure coordinated and effective care for individuals with mental health, developmental disabilities, and substance abuse needs.
What information must be reported on nc mhddsas health plan?
Information such as patient demographics, treatment plans, medication management, and progress notes must be reported on the nc mhddsas health plan.
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