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2019 EXPENSE REIMBURSEMENT FORM PLEASE PRINT LEGIBLY:Date of Trip/Presentation:Purpose:Name: Address: City:State:Phone:Zip:Email Address:REIMBURSABLE EXPENSES: Auto Allowance (0.545 cents per mile) Gas
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The Collaborative Care Model (CoCM) is a framework for providing integrated behavioral health care in primary care settings, where primary care providers and mental health professionals work together to treat patients.
Healthcare providers and organizations participating in the Collaborative Care Model must file the form, particularly those billing for collaborative care services.
To fill out the form, providers need to include patient information, treatment plans, care coordination details, and appropriate billing codes as required by the form's guidelines.
The purpose of the Collaborative Care Model form is to ensure that integrated behavioral health services are documented and billed properly, thereby improving patient care and outcomes.
Information required includes patient demographics, clinical assessments, treatment plans, referral information, and progress notes from the care team.
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