Providers (Psychiatrists, Psychologists, Social Workers, Licensed Professional Counselors, Licensed Marriage & Family Therapists, Nurse Practitioners, etc.) providing services through the insurance side of members benefit plans.
IMPORTANT INFORMATION ABOUT CLAIMS:
Please submit all insurance related billing to Mines at:
MINES and Associates Claims
P.O. Box 270669
Littleton, CO 80127
To check benefits, eligibility or exclusions, please check the client's insurance card.
PPO/Managed Care Forms
Medication Evaluation/Management Treatment Plan
To be completed by prescribing provider who provides medication management only! If provider provides medication management and therapy please, instead, complete PPO/Managed Care
Evaluation/Treatment Plan below.
PPO/Managed Care Evaluation/Treatment Plan
To be completed by those who are providing psychotherapeutic services to clients
Additional information in PDF* format:
Reviews required procedures for those providing services to insure reimbursement
Authorization for Release of Health Information
To be completed when confidential health information needs to be released
Summary of Responsibilities for Managed Care Clients
Outlines responsibilities of providers, clients and insurance company
*You will need Adobe Acrobat Reader to view the files in this section. If you do not have a copy of Acrobat Reader, you can download a free copy of Acrobat Reader : here. (This link will open a new window and your computer must have the capability of downloading a 5.5 mg file.)
Please note:If you are using Acrobat Reader 3.0 or older, you may experience problems viewing our files.