vns health referral form
Change Health Care Commercial Par Payer Listing: 8/9/2017
form. 4 ICS Software, Ltd. 12 PayerId 71084 HSM01 37272 37283 87815 75250 referral claims. Medical Record Number (Member ID) format should be all
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DMA-3163, CAP/C Referral Form
Please submit this form via fax to 919 715 0052, or by mail to Division of Medical Assistance, CAP Unit, 2501 Mail Service. Center, Raleigh, NC 27699-2501.
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Vagus Nerve Stimulation (VNS Therapy)
If youre interested in VNS therapy for treatment-resistant depression, you will need to fill out a screening form and get a referral from your primary care
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