Cenpatico behavioral health of arizona pm form 3.14.4 out-of ... 2025

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The document is a form (PM Form 3.14.4) used by Cenpatico Behavioral Health of Arizona for requesting out-of-network services for participants. It includes sections for participant information, requested out-of-network services, and provider details, along with clinical rationale and necessary credentials for the out-of-network provider. The form aims to ensure that all in-network options have been explored before seeking external services.

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2010	4.8 Satisfied (120 Votes)

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