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Medical Fee Dispute Resolution Findings and Decision
General Information
Requestor Name
NEVA VIDA BEHAVIORAL HEALTHRespondent Name
TEXAS MUTUAL INSURANCE COMPANYMFDR Tracking Number
M423015101Carriers
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How to fill out 96158 and 96159
How to fill out 96158 and 96159
01
To fill out form 96158, follow these steps:
02
Start by providing your personal details such as your name, address, and contact information.
03
Indicate the purpose for filling out the form, such as enrollment in a particular program or seeking medical assistance.
04
Provide any relevant identification numbers or codes that may be required.
05
Fill in the necessary information regarding your healthcare provider or institution.
06
Provide details about the services or procedures for which you are seeking reimbursement or approval.
07
Include any supporting documentation or attachments as requested by the form.
08
Review the completed form for accuracy and completeness before submitting it.
09
To fill out form 96159, follow these steps:
10
Begin by entering your personal information, including your name, address, and contact details.
11
Indicate the reason for completing the form, whether it is for medical billing or authorization purposes.
12
Provide any relevant identification numbers or codes related to your healthcare coverage or situation.
13
Fill in the details of the healthcare service or procedure for which you are seeking reimbursement or authorization.
14
Include any supporting documents or attachments as required by the form.
15
Double-check the form to ensure all information is accurate and complete.
16
Submit the form according to the instructions provided.
Who needs 96158 and 96159?
01
Form 96158 is typically needed by individuals who require reimbursement or approval for specific healthcare services or procedures. This can include patients seeking coverage for treatments, enrollees in certain healthcare programs, or individuals applying for medical assistance.
02
Form 96159 is commonly needed by healthcare providers, billing departments, or individuals seeking reimbursement or authorization for medical services. This form helps facilitate the reimbursement process and ensures proper authorization is obtained.
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What is 96158 and 96159?
96158 and 96159 are CPT (Current Procedural Terminology) codes used for billing and documentation of psychotherapy services provided by healthcare professionals.
Who is required to file 96158 and 96159?
Healthcare providers who offer psychotherapy services, such as psychologists, psychiatrists, and other licensed mental health professionals are required to file these codes when billing for their services.
How to fill out 96158 and 96159?
To fill out 96158 and 96159, providers should document the type of service provided, the duration of the session, and any relevant patient information. Accurate patient details, treatment dates, and session specifics should be included in the billing forms.
What is the purpose of 96158 and 96159?
The purpose of 96158 and 96159 is to standardize the billing process for psychotherapy services, ensuring that providers are compensated for their work and that insurance claims are processed accurately.
What information must be reported on 96158 and 96159?
The information that must be reported on 96158 and 96159 includes the patient's name, date of service, type of therapy provided, duration of the session, and the provider's details including their credentials.
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