Financial Screening Manual – NGA (Rev Sept 2023)
Payer Financial Information Form
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Uniform Patient Fee Schedule: Community Mental Health Services
Reevaluation Follow-Up Letter (Rev Sept 2023)
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Insurance Authorization and Assignment of Benefits (Rev Sept 2023)
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Financial Obligation Agreement (Rev Sept 2023)
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Financial Profile Verification Request (Rev Sept 2023)
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Verification of In-Kind Source of Income (Rev Sept 2023)
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