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Ash reopen modification form 2025

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The document provides instructions for completing standardized reporting tools for physical and occupational therapy services by American Specialty Health Group, Inc. It outlines the necessary forms, including the Initial Health Status form, Medical Necessity Form, and Reopen/Modification form, which are designed to facilitate effective communication of a patient's health status and medical necessity. The document emphasizes the importance of accurate data submission to ensure equitable evaluation and prompt responses from ASH Group.

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Click ‘Get Form’ to open the ash reopen modification form in the editor.
Begin by filling in the patient’s name, ID number, and health plan details at the top of the form. This information is crucial for identifying the patient and ensuring accurate processing.
Select whether you are submitting a Reopen or Modification request. For Reopen, provide additional information for clinical review; for Modification, specify any new treatment/services or changes to approved dates.
In the rationale section, clearly explain why you are submitting this request. Attach any necessary documents that support your submission.
Ensure to check the box for patient consent if required by state regulations, especially for Reopen submissions in Ohio.
Finally, sign and date the form at the bottom to attest to its accuracy before submitting it through our platform.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for American Specialty Health Human Resources?

To request an accommodation, contact Human Resources at 800.848. 3555, ext. 6702.

How to join American Specialty Health?

How do I join ASH? If you are interested in becoming an ASH provider, please call 888.511. 2743 and one of our representatives will assist you.

How do I contact ASHLink customer service?

If you have questions, please contact ASH Customer Service at 1-800-848-3555.

How do I contact Ash?

E-MAIL: service@ashn.com. MAIL: American Specialty Health, P.O. Box 509001, San Diego, CA. 92150-9001. PHONE: (Please use the Customer Service phone number for your specialty) Acupuncture - (800) 972-4226. Chiropractic - (800) 972-4226. Dietetics - (800) 972-4226. Massage Therapy - (800) 972-4226.

How do I contact Ashcare?

Contact Customer Service by telephone at either the appropriate client specific number, the general number (1-888-990-2746) or by mail, (PO Box 509040, San Diego, CA 92150- 9040) to: Start and end the program when you want. Ask a question.

What is the phone number for American Specialty Health Clearinghouse?

Provider Questions: If you are a health provider and have questions, call (800) 972-4226 Monday-Friday 5 a.m. - 6 p.m. (PST). General Inquiries: If you have other questions, call (800) 848-3555 or visit our contact us page.

Ash reopen modification form 2025

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