ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
ABA Financial Packet
- Gathering accurate information during patient intake is the key to prompt insurance reimbursement. Simplify the collection of financial information with this package.
- Package includes:
- (Bold Denotes form also available for purchase separately)
- *ABA Insurance Benefit Verificaiton Form w/ instructions (2 pages)
- *ABA Benefit Notification Form w/ instructions (Client Facing, 2 pages)
- *Demographic and Insurance Information Form (1 page)
- *Financial and Billing Policies (2 pages, customizable with your clinic name/information)
- *Recurring Credit Card Charge Authorization Form (1 page)
- 9 pages (not all are pictured in preview window)
- $45.99 As-is, Word Doc Only (You customize)
- $59.99 Customized with Clinic Info, Word and PDF
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Packet
ABA Client Intake Pacekt
ABA Client Intake Packet
This packet includes all of the elementsof the Financial Packet, plus other intake forms. Everything you need to get started accepting clients - perfect for start-ups!
Contains forms that will need to be customed with your clinic name and contract information.
Includes all the components of our ABA Financial Packet PLUS:
*Introductory Letter
*Table of Contents
*Client Services Agreement
*Consent for ABA
*Notice of Privacy Practices and HIPAA Compliance
*PHI Release
*Video/Photograph Release
*Patient History Form (Social, Medical, Educational, Behavioral)
*Emergency Contact Page
*Approved Pick-Up Persons Page
40 pages total (not all are pictured in preview window)
$129.99 (Word.doc only, You Customize)
$169.99 (Customized with Clinic Info, Word.doc and PDF)
Financial Hardship Policy & Waiver
Financial Hardship Policy & Waiver
Financial Hardship Policy & Waiver
Financial Hardship Policy & Waiver
Financial Hardship Policy & Waiver
Financial Hardship Policy & Waiver Package
Routine waiver of copays is ILLEGAL - you must have documentation of finanical hardship in order to waive patient cost shares. Protect your practice and remain in compliance with your payor contracts with our Financial Hardship Policy Package.
Package includes Word and PDF versions of:
* Informational handout for clients* Implementation guide for providers* Application for short-term (3 mo) copay/deductible waiver* Application for long-term (12 mo) copay/deductible waiver
Can use as-is or customize to suit your needs.
24 pages (not all pages are pictured in preview window)
$249.99
ABA Financial Packet PLUS
ABA Financial Packet PLUS
ABA Financial Packet PLUS
ABA Financial Packet PLUS
ABA Financial Packet PLUS
ABA Financial Packet PLUS
ABA Financial Packet PLUS Financial Hardship Policy & Waiver Packet
Our Financial Packet and our Financial Hardship Policy Packet in one package. Save $26.00 by purchasing both in one package.
*Not all pages are pictured in preview screen. Refer to listings for ABA Financial Packet and Financial Hardship Policy Package for a complete listing of all included components.
29 pages (not all are pictured in preview window)
****SAVE $26.00!****
$269.99 (Word.doc only, You customize)
$309.99 (Customized with Clinic Info, Word and PDF)
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS
ABA Intake Packet PLUS Financial Hardship Policy & Waiver Packet
Save with our ultimate financial and intake package! This package includes the Financial Packet, Financial Hardship Policy & Waiver Packet and the Client Intake Packet all in one!
Refer to each indivdual packet's listing for a complete list of contents.
69 pages (not all are pictured in preview window)
**** SAVE $50.00!****
$349.99 (Word.doc Only, You Customize)
$399.99 (Customized with Clinic Info, Word and PDF)
ABA Benefit Notification Form
ABA Benefit Notification Form
ABA Benefit Notification Form
People do not pay bills/costs they don't understand - maintain healthy revenue collection by helping people understand their cost share.
Communicate results of benefit verifications to your clients in a clear, concise way.
Specifically tailored for ABA and includes a 2nd page with definitions of common cost share terms (deductible, co-insurance, etc) that you can give to parents to help them understand their benefits.
2 pages
$10.00
ABA Benefit Verification Form
ABA Benefit Verification Form
ABA Verification of Benefits Form
Nothing is worse than rendering 3 months of ABA services, only to find out an authorization is required and one wasn't obtained.
Thorough insurance benefit verification via phone (not online) is the best way to stop these unpleasant surprises.
This form is specifically tailored for ABA and contains all of the questions you need to ask to make sure you have a complete understanding of your patient's coverage.
Purchase includes both the Word document and fillable PDF versions of the form.
2 pages
$10.00
Pediatric Therapy Benefit Verification Form
Pediatric Therapy VOB Form
Pediatric Therapy Verification of Benefits Form
Nothing is worse than rendering 3 months of services, only to find out an authorization is required and one wasn't obtained.
Thorough insurance benefit verification via phone (not online) is the best way to stop these unpleasant surprises. This form contains all of the questions you need to ask to make sure you have a complete understanding of your patient's coverage.
Specifically tailored for PT/OT/ST
Purchase includes both the Word document and fillable PDF versions of the form.
2 pages
$10.00