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  • Co Community Health Alliance Mental Health Outpatient Treatment Report Form 2018

Get Co Community Health Alliance Mental Health Outpatient Treatment Report Form 2018-2025

Ata Patient name: Medicaid ID: Address: City, state: Provider information Provider name: Tax ID: PCP name: Name of other behavioral health providers: DSM-V diagnoses Date of birth: ZIP code: Phone: Medications Current medications (indicate changes since last report): Fax: PCP NPI: Dosage: Frequency: Current risk factors Suicide: None Ideation Intent without means Intent with means Contracted not to harm self Homicide: None Ideation Intent without means.

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Both professional billers and facilities have 120 days from the date of the service to submit a clean claim to Colorado Community Health Alliance (CCHA) for processing when CCHA is the primary payer. If CCHA is the secondary payer, the time period is 365 days.

The state contracts with two local, nonprofit plans (Denver Health Medicaid Choice, a risk-based managed care organization, and one limited benefit prepaid health plan, Rocky Mountain HMO) to provide services for its MCO program, and the availability of each plan varies by region.

Colorado Access is a nonprofit health plan. We have many programs to help you take charge of your health. Colorado Access helps Health First Colorado (Colorado's Medicaid Program) members in Denver County. We also help members outside Denver County if they get primary care from one of our providers.

Colorado Community Health Alliance (CCHA) is the Health First Colorado (Colorado's Medicaid Program) regional organization serving the counties of Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller.

Health First Colorado (Colorado's Medicaid Program) is free or low cost public health insurance for Coloradans who qualify.

As a Health First Colorado (Colorado's Medicaid Program) member you get access to physical health, behavioral health, dental care, and other resources such as food, housing, transportation and childcare. CCHA services are part of your Health First Colorado benefits, so there is no cost to you.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232