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Inpatient Admission Notification Form This form is to be used to notify Avert Health Plans of an in network inpatient admission. Please complete each section of this form. **Incomplete forms will
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How to fill out behavioral health inpatient notification
How to fill out behavioral health inpatient notification
01
Obtain the necessary forms from your healthcare provider or insurance company.
02
Fill in your personal information including name, date of birth, and insurance information.
03
Provide a detailed description of the behavioral health issue requiring inpatient care.
04
Include any relevant medical history, medications, and previous treatments.
05
Have the form signed by your healthcare provider to authorize the inpatient notification.
Who needs behavioral health inpatient notification?
01
Individuals who require inpatient behavioral health care services.
02
Healthcare providers or insurance companies who need to authorize and coordinate inpatient care for patients.
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What is behavioral health inpatient notification?
Behavioral health inpatient notification is a process of reporting admissions of patients to behavioral health facilities.
Who is required to file behavioral health inpatient notification?
Healthcare providers and facilities are required to file behavioral health inpatient notification.
How to fill out behavioral health inpatient notification?
Behavioral health inpatient notification can be filled out electronically or through designated paper forms provided by the state health department.
What is the purpose of behavioral health inpatient notification?
The purpose of behavioral health inpatient notification is to track and monitor patient admissions to behavioral health facilities for quality and safety purposes.
What information must be reported on behavioral health inpatient notification?
Information such as patient demographic details, referring provider information, admission date and time, primary diagnosis, and treatment plan must be reported on behavioral health inpatient notification.
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