Masscollaborative.org

Mass Collaborative

WEBThe Mass Collaborative is a voluntary open organization of more than 35 payers, providers, and trade associations dedicated to reducing complex and cumbersome health care …

Actived: 3 days ago

URL: http://www.masscollaborative.org/

INTRODUCING: UNIVERSAL PROVIDER REQUEST FOR CLAIM …

WEB7 (continued on next page) Massachusetts Collaborative — Introducing: Universal Provider Request for Claim Review Form June 2023 Category Documentation Requirement

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MASSACHUSETTS STANDARD FORM FOR MEDICATION …

WEBharm to the member? ☐ Yes No If yes, briefly describe details of contraindication, adverse reaction, or harm: Is the alternative drug required under the step therapy protocol …

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PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL ASSESSMENT …

WEBPSYCHOLOGICAL AND NEUROPSYCHOLOGICAL . ASSESSMENT SUPPLEMENTAL FORM. Provide . specific. information in context of each health plan’s unique medical

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PET – PET CT PRIOR AUTHORIZATION FORM

WEB1 Massachusetts Collaborative — PET – PET CT Prior Authorization April 2019 (version 1.0) PET – PET CT PRIOR AUTHORIZATION FORM

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STANDARDIZED PROVIDER INFORMATION CHANGE FORM

WEBSTANDARDIZED PROVIDER INFORMATION CHANGE FORM (CONTINUED) Provider Name: SUBMISSION INFORMATION: Blue Cross Blue Shield of MA Provider …

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REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION …

WEB2 Massachusetts Collaborative — Repetitive Transcranial Magnetic Stimulation Request Form January 2019

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MASSACHUSETTS STANDARD FORM FOR APPLIED BEHAVIOR …

WEB1(continued on next page) Massachusetts Standard Form for Applied Behavior Analysis Services Prior Authorization Requests September 2023 MASSACHUSETTS …

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INTRODUCING: UNIVERSAL PROVIDER REQUEST FOR CLAIM …

WEB7(continued on next page) Massachusetts Collaborative — Introducing: Universal Provider Request for Claim Review Form January 2019 Category Documentation Requirement

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MASSACHUSETTS MEDICAL PRICE TRANSPARENCY LAW AND …

WEBMassachusetts Collaborative — Price Transparency Information Worksheet January 2015 COST ESTIMATE WORKSHEET PATIENT INFORMATION (TO BE COMPLETED BY …

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MASSACHUSETTS STANDARD FORM FOR MEDICATION …

WEB2 Massachusetts Collaborative — Massachusetts Standard Form for Medication Prior Authorization Requests April 2019 (version 1.0) F.atient Clinical Information P

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Introducing: Standardized Prior Authorization Request Form

WEBIntroducing: Standardized Prior Authorization Request Form The Massachusetts Health Care Administrative Simplification Collaborative*, a multi‐stakeholder group

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CARDIAC IMAGING PRIOR AUTHORIZATION FORM

WEB2 Massachusetts Collaborative — Cardiac Imaging Prior Authorization Form April 2019 (version 1.0)

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BEHAVIORAL HEALTH — LEVEL OF CARE REQUEST FORM

WEBPartial Hospitalization ☐ Community Stabilization/Treatment (☐ ICBAT ☐ CBAT ☐ CCS/CSU) ☐ Residential ☐ Outpatient Psychotherapy (except 90837/90838) ☐ …

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