№ lp_1_30822
File format: docx
Character count: 2644
File size: 761 KB
Patient request form for access to billing records.
Note:
Date
Email:
[email protected]
FAX:
866-942-7487
Mail:
Dignity Health IZ request, PO Box 3008, Rancho Cordova, CA 95741
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2023
Region / City:
United States
Topic:
Health Data Collection, Public Health Research, Survey Design
Document Type:
Federal Notice
Agency:
Centers for Disease Control and Prevention (CDC)
Author:
Centers for Disease Control and Prevention (CDC)
Target Audience:
Public, Federal Agencies, Health Researchers
Period of Effect:
Ongoing, with quarterly surveys
Approval Date:
06/30/2022
Modification Date:
Not specified
Year:
2022
Region / City:
Canberra
Topic:
Healthcare billing guidelines
Document Type:
Guideline
Organization / Institution:
Canberra Health Services
Author:
Canberra Health Services
Target Audience:
Clinical and administrative staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2025
Region / City:
California
Topic:
Specialty Mental Health Services Billing
Document Type:
Manual
Organization / Institution:
Department of Health Care Services (DHCS)
Author:
Department of Health Care Services
Target Audience:
Mental Health Plans (MHP), Billing Vendors, Providers of Specialty Mental Health Services
Effective Period:
SFY 2025-26
Approval Date:
July 2025
Amendment Date:
Not specified
Note:
Year
Theme:
Billing Account Name Change
Document Type:
Instructional Guide
Organization / Institution:
Microsoft
Target Audience:
Microsoft customers requesting Billing Account name changes
Year:
2023
Region / City:
Massachusetts
Topic:
Intensive Community Services, Billing Procedures
Document Type:
Guidelines
Organization / Institution:
Massachusetts Department of Mental Health
Author:
Massachusetts Department of Mental Health
Target Audience:
Service Providers
Period of Validity:
Ongoing
Approval Date:
6/14/23
Date of Changes:
Not specified
Program:
Home and Community-based Services (HCS)
Document type:
Billing requirements
Governing body:
Health and Human Services Commission
Jurisdiction:
Texas
Legal basis:
40 TAC §9.170
Provider obligations:
Service claim preparation and submission
Effective dates:
January 1, 2023; March 1, 2023; November 15, 2019; September 1, 2021
Revision identifiers:
Revision 19-1; Revision 21-3; Revision 23-1; Revision 23-2
Service components covered:
Professional therapies, residential assistance, respite, nursing, employment services, adaptive aids, home modifications, dental treatment, transition assistance
Compliance oversight:
Provider Fiscal Compliance Reviews
Appendices included:
Provider Fiscal Compliance Review Protocol, forms, revisions, contact information
Year:
2022
Region / City:
Victoria, Australia
Topic:
Healthcare policy, Medicare billing
Document type:
Policy guidelines
Agency / Institution:
Department of Health, Victorian Government
Author:
Victorian Department of Health
Target audience:
Public hospitals, health practitioners, hospital administrators
Effective period:
Ongoing
Approval date:
July 2022
Revision history:
Not specified
Year:
2020
Region / City:
Pennsylvania
Topic:
Billing Document Cancellation
Document Type:
Instructional Guide
Organization / Institution:
The Pennsylvania State University
Author:
Labyrinth Solutions, Inc.
Target Audience:
Penn State Staff and Users
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Context Description
Year:
2023
Region / City:
Roswell
Topic:
Utility Billing, Customer Self Service
Document Type:
Instruction Manual
Organization:
City of Roswell
Author:
City of Roswell
Target Audience:
Utility Customers
Effective Period:
Ongoing
Approval Date:
N/A
Revision Date:
N/A
Year:
2023
Region / City:
United States
Topic:
Integrated Billing, Updates and Patches
Document Type:
Technical Manual
Agency / Organization:
Department of Veterans Affairs, Office of Information and Technology
Author:
MCCF EDI TAS eBilling Development Team, CCDSO IB AR Development Team, Cerner Pharmacy CoPay Team
Target Audience:
Internal VA staff, IT and technical teams, developers
Period of Validity:
March 2023
Approval Date:
March 2023
Date of Last Update:
March 2023
Year:
2026
Region / City:
Kingston, Massachusetts
Theme:
Real Estate Tax Billing, Municipal Liens
Document Type:
Letter
Authority / Organization:
Town of Kingston, Office of the Tax Collector
Author:
Kenneth G. Moalli, Tax Collector; Debora Barry, Assistant Collector
Target Audience:
Attorneys, Financial Institutions, Property Owners
Period of Validity:
Fiscal Year 2026
Approval Date:
July 1, 2025
Date of Changes:
None
Organization:
Department of Veterans Affairs
Office:
Office of Information and Technology
Document type:
User guide
System:
Integrated Billing
Version:
2.0
Publication date:
September 2023
Revision history start date:
December 29, 2004
Latest revision:
3.31
Latest update date:
September 2023
Contributors:
MCCF EDI TAS eInsurance; CC DSO Development Team; Liberty IT Solutions SHRPE Team; Cerner Pharmacy CoPay Team; CC IBAR Enhancements; Urgent Care IBAR Enhancements
Subject areas:
Veterans billing; insurance; copayments; reports; eligibility; urgent care
Intended users:
Billing staff; CPAC users; facility revenue managers
Year:
2019
Region / City:
Kennedale, Texas
Topic:
Emergency Medical Services Billing and Collections
Document Type:
Request for Proposal (RFP)
Organization / Institution:
City of Kennedale, Texas Fire Department
Author:
Not specified
Target Audience:
Contractors for Emergency Medical Services Billing and Collections
Period of Effect:
36 months, with an option for annual extensions
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
1994
Region / City:
United States
Subject:
Healthcare, Software Development
Document Type:
Technical Manual
Organization / Institution:
Department of Veterans Affairs, Office of Information and Technology (OI&T)
Author:
MCCF EDI TAS eInsurance Development Team, MCCF EDI TAS eBilling Development Team, CTT/DM NDS Development Team, and others
Target Audience:
Developers, IT professionals, and VA employees involved in eBilling and insurance systems
Effective Period:
September 1994, Updated October 2019
Approval Date:
September 1994
Date of Changes:
October 2019
Year:
2026
Region / City:
Longview, TX
Subject:
Utility Billing, Automatic Bank Draft
Document Type:
Agreement
Organization / Institution:
City of Longview Utility Billing Services
Author:
City of Longview
Target Audience:
Utility customers in Longview
Effective Period:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Context:
A form that allows residents of Longview, TX to sign up for automatic bank draft payments for utility services, with detailed instructions for completing and submitting the agreement.
Year:
2026
Region / City:
Mesquite, TX
Subject:
Police Records Request
Document Type:
Request Form
Organization:
Mesquite Police Department
Author:
Mesquite Police Department
Target Audience:
General public, legal professionals, requestors of police records
Effective Period:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Context
Year:
2025
Note:
Region / City
Theme:
Data definitions, Medical records, Extract files
Document Type:
Technical document
Organization / Institution:
Department of Veterans Affairs Office of Information and Technology
Author:
Booz Allen Hamilton, Liberty IT Solutions
Target Audience:
DSS/MCA teams, IT professionals
Contextual description:
This document provides technical details on data extraction routines and data definitions for various medical records files used in the Decision Support System.
Year:
2022
Region / City:
East Sussex
Subject:
Records Management
Document Type:
Job Description
Organization / Institution:
East Sussex County Council
Author:
East Sussex County Council
Target Audience:
Potential applicants for the Records Clerk position
Period of Action:
Ongoing
Approval Date:
October 2022
Date of Amendments:
October 2022
Year:
2014
Region / City:
United States
Topic:
Request for Medical Records
Document Type:
Form
Organization / Institution:
National Archives and Records Administration
Author:
National Personnel Records Center
Target Audience:
Military personnel, retirees, federal employees, and their dependents
Effective Period:
Ongoing
Approval Date:
May 2014
Date of Amendments:
None
Year:
2014
Region / City:
Delaware
Topic:
Court Records Access Policy
Document Type:
Policy Directive
Agency / Institution:
Justice of the Peace Court
Author:
Alan G. Davis, Chief Magistrate
Target Audience:
All Justices of the Peace, All Non-Judicial Court Employees
Effective Date:
October 21, 2014
Date of Approval:
October 21, 2014