Get the up-to-date pacificare treatment 2024 now

Show details

4.8 out of 5

100 votes

of Visits Requested DIAGNOSIS ICD-9 CM CODE EVALUATION TREATMENT PLAN RVS/CPT 4 CODE REQUESTED FACILITY Accident Yes No Occurrence Work Auto Other Insurance MD Signature Date NOTE The member has the right to appeal denial of services through PacifiCare/Secure Horizons PLEASE CHECK ELIGIBILITY PRIOR TO PROVIDING SERVICE. Authorization Provider Contracted Yes Facility Contracted Assigned Length of Stay Authorized Initials Pended Modified CPT Codes Authorized/No. of Visits Reason SE 7-26-00. ROUT ...

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to modify Pacificare treatment in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our comprehensive and user-friendly PDF editor is simple. Make the steps below to complete Pacificare treatment online quickly and easily:

Log in to your account. Log in with your email and password or create a free account to try the product before choosing the subscription.
Import a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Pacificare treatment. Quickly add and highlight text, insert images, checkmarks, and icons, drop new fillable areas, and rearrange or delete pages from your document.
Get the Pacificare treatment accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Take advantage of DocHub, the most straightforward editor to quickly manage your documentation online!

See more pacificare treatment versions

We've got more versions of the pacificare treatment form. Select the right pacificare treatment version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2000	4.8 Satisfied (100 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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 kind of insurance is PacifiCare?

On the Group health insurance market in California, Pacificare is still very strong in terms of pricing and benefits and they have partnered with United Health for a full suite offering of PPO and HSA plans while they concentrate on their traditional strong suit of HMO plans.

When did UHC buy PacifiCare?

PacifiCare Health Systems, Inc. was a provider of health insurance based in Cypress, California. It was acquired by UnitedHealth Group in December 2005.