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PATIENT REFERRAL FORM NC MBS Referrals TO: Scheduling Office EMAIL: ncschedule@patheoushealth.com FROM:PHONE:DON:ADM:FAX:SLP & CELL:Patient Name:DOB:Ordering Physician: Payor: Insurance cards attached?
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How to fill out nc mbs referrals
How to fill out nc mbs referrals
01
Obtain the necessary referral form from the NC MBS website or your healthcare provider.
02
Fill out the patient's personal information including name, date of birth, and contact details.
03
Provide details of the referring healthcare provider, including their name, contact information, and provider number.
04
Clearly state the reason for the referral and any relevant medical history or conditions.
05
Ensure all sections of the form are completed accurately and legibly.
06
Submit the completed referral form to the appropriate department or healthcare provider as instructed.
Who needs nc mbs referrals?
01
Patients who require specialized medical services or treatments that are covered under the NC MBS scheme.
02
Healthcare providers who are referring patients for specific medical procedures or consultations.
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What is nc mbs referrals?
NC MBS referrals refer to referrals made to the North Carolina Medicaid and Health Choice Programs by healthcare providers.
Who is required to file nc mbs referrals?
Healthcare providers who participate in the North Carolina Medicaid and Health Choice Programs are required to file NC MBS referrals.
How to fill out nc mbs referrals?
NC MBS referrals can be filled out online through the North Carolina Medicaid and Health Choice Programs website or submitted through the electronic submission process.
What is the purpose of nc mbs referrals?
The purpose of NC MBS referrals is to ensure that healthcare services provided to Medicaid and Health Choice recipients are appropriately reported and billed.
What information must be reported on nc mbs referrals?
Information such as the patient's demographics, diagnosis, procedure codes, and provider information must be reported on NC MBS referrals.
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