Provider Relations LME Forms
STR UNIFORM SCREENING & REGISTRATION FORM
(electronic version)
STR UNIFORM SCREENING & REGISTRATION FORM
(print & fill out version)
Min Req for Providers who bill thru SRLME Final Revision
(revised 9/13/07)
CareLink Procedure Code Billing Guide
(added 9/11/07)
Array
of Services - 0607 - Master 4-3-07
(added 4/30/07)
IPRS
Eligibility Matrix 4-17-07
(added 4/30/07)
Provider
Billing Information Form
(update of 5/16/07)
Provider Billing
Requirements Procedure
(update of 04/26/07)
Form Instructions
Client Billing Information (update of 04/26/07)
Diagnosis
Crosswalk (update 3/20/07)
Care
Link Billing Instructions
Revised
NPI Form
Instructions
for Completing Service Authorization Request Form
Justification
for Continued Stay Form
Monthly
Collection Report Form
Out
of Home Community Placement Form
Perform
Provider Profile Form
Provider
Choice Acknowledgement Form
Provider Physical Location Form revised 083107
Service
Authorization Form
Transfer
Referral Form
Psychiatric
Referral Form
Demographic
Form
Discharge
Process and Termination
Request Form
Room
& Board Letter - Parent Guardian
Room
& Board Letter - DDS
Room
& Board Letter - Auth of R&B
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