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Fancier Behavioral Health Inpatient Request Form (page 13)
AETNA BETTER HEALTHSUNFLOWER HEALTH PLANNED Healthcare 18552254102
Phone 18552215656Fax 18448247705
Phone 18776444623Fax 18552689392
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How to fill out KanCare Behavioral Health Inpatient Request Form
How to fill out KanCare Behavioral Health Inpatient Request Form
01
Obtain the KanCare Behavioral Health Inpatient Request Form from the appropriate provider or online portal.
02
Fill out the patient's personal information, including name, date of birth, and identification number.
03
Provide details about the referring provider, including their name, contact information, and provider ID.
04
Indicate the type of service being requested, specifying 'Inpatient Behavioral Health Care.'
05
Include the patient's clinical history, including any relevant diagnoses and treatment history.
06
Provide supporting documentation that justifies the need for inpatient care, such as previous treatment notes or assessments.
07
Specify the expected length of stay and any specific treatment needs or interventions required.
08
Review the form for completeness and accuracy to ensure all necessary information is included.
09
Sign and date the form, acknowledging the information provided is true and accurate.
10
Submit the form to the appropriate KanCare authority or organization for review.
Who needs KanCare Behavioral Health Inpatient Request Form?
01
Individuals who require inpatient behavioral health treatment and their healthcare providers must fill out the KanCare Behavioral Health Inpatient Request Form.
02
Patients who have health coverage under KanCare that includes mental health services will need this form to access inpatient care.
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What is KanCare Behavioral Health Inpatient Request Form?
The KanCare Behavioral Health Inpatient Request Form is a document used to request authorization for inpatient mental health services under the KanCare program.
Who is required to file KanCare Behavioral Health Inpatient Request Form?
Providers of mental health services, such as hospitals or treatment facilities, are required to file the KanCare Behavioral Health Inpatient Request Form on behalf of patients requiring inpatient mental health treatment.
How to fill out KanCare Behavioral Health Inpatient Request Form?
To fill out the KanCare Behavioral Health Inpatient Request Form, providers should accurately complete all required sections, providing detailed patient information, diagnosis, treatment plan, and justification for inpatient admission.
What is the purpose of KanCare Behavioral Health Inpatient Request Form?
The purpose of the KanCare Behavioral Health Inpatient Request Form is to ensure that necessary inpatient mental health services are authorized and appropriately funded under the KanCare program, facilitating access to vital care for individuals in need.
What information must be reported on KanCare Behavioral Health Inpatient Request Form?
The information that must be reported on the KanCare Behavioral Health Inpatient Request Form includes patient demographics, clinical assessment details, treatment history, specific diagnosis codes, and the rationale for inpatient care.
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