Forms
Authorization Services / Clinical_Templates / DATAR / Information Systems Services Requests / InSyst / Prop 36 Tracking / QA/CQRT
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Please download the file and save on it on your local computer for future use. Authorization Services
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| Client Registration | WORD | PDF (rev. 5/16/06) | |
| Episode Opening | WORD | ||
| Episode Closing | WORD | PDF (rev. 5/16/06) | |
| Administrative Discharge Closing | WORD | ||
| Episode Annual Update | WORD |
-
MHS Client Data Collection (CSI) Forms (effective 7/1/06)
| Client Registration | WORD | PDF (rev. 07/14/06) | |
| Episode Opening | WORD | PDF (rev. 07/14/06) | |
| Episode Closing | WORD | PDF (rev. 07/07) | |
| Individual Staff Service | WORD | PDF (rev. 08/14/06) | |
| CalWORKS Individual Staff Log | WORD | PDF (rev. 10/05/06) | |
| Periodic Form | WORD | PDF (rev. 07/10/06) | |
| InSyst Table of Codes | WORD | PDF (rev. 08/14/06) | |
| MAA Form (codes on the back of the form) |
EXCEL | PDF (rev. 06/23/06) |
Service Entry Codes- code removed.
EFF: 7/21/06 – REMOVED SERVICE LOCATION CODE: 21-UNKNOWN
CODE 21-UNKNOWN IS NOT MEDI-CAL BILLABLE – ALL SERVICES BEGINNING JULY 2006.
- Staff Number
(MHS
/
AOD)
- to acquire an InSyst staff
number for clinical staff
(NOTE: staff numbers will not be issued without NPI and Taxonomy code. Please see http://www.acbhcs.org/Providers/NPI/NPI.htm for more information.) - User Authorization (MHS / AOD) - to setup InSyst username and access to InSyst database
- Disallowed Claim Systems (DCS) - to report services claimed in error. Please read the instructions on how to report errors to BHCS.
- Beneficiary Registration For Prior Consultation
- Request for Prior Consultation
- Client Data Registration
- Client Data Update
Prop 36 Tracking
- Authorization Request Form - to setup a User ID and Password for the Prop 36 Tracking System
Quality Assurance/Clinical Quality Review Team
