A Single Case Agreement allows individuals with benefit plans lacking out-of-network coverage to receive services from non-contracted professionals using their in-network benefits, granted as an exception by Cenpatico under specific conditions such as geographical remoteness, lack of clinical specialty within the network, or to ensure continuity of care. These agreements are established on a situation-by-situation basis, where non-contracted professionals must agree to certain terms, including accepting a predetermined rate as full payment and not billing the enrollee for unauthorized services. For those seeking to utilize this option, completing and submitting the Single Case Agreement form is the first step. Click the button below to get started.
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In the realm of behavioral health services, the adaptability and client-centered approach embodied by the Single Case Agreement form play a crucial role in bridging gaps within healthcare provision. Designed to facilitate access to care when standard network limitations might otherwise stand in the way, these agreements serve as an exceptional mechanism, ensuring that individuals receive the requisite care despite existing network barriers. The form itself prompts a comprehensive submission process, outlining specific criteria and necessary documentation to qualify for an exception. This might include situational factors such as geographical remoteness, lack of a clinical specialty within the network, or the need for continuity of care to prevent harm to the individual or others. For non-contracted professionals seeking to provide care under such agreements, the process involves a detailed review and submission of the form, alongside adherence to agreed-upon terms including rates and payments. The submission addresses elements ranging from member and provider information to detailed service and diagnosis codes, ensuring a thorough review process. Each Single Case Agreement is authorized uniquely, emphasizing a case-by-case consideration, with a clear set of terms that safeguard both the individual receiving care and the provider delivering it, thus embodying a significant step towards more inclusive and accessible behavioral health services.
| Question | Answer |
|---|---|
| Form Name | Single Case Agreement Template Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | cenpatico single case agreement form, how to request a single case agreement, single case agreement behavioral health, single case agreement |
Cenpatico Single Case Agreements
SINGLE CASE AGREEMENTS FOR BEHAVIORAL HEALTH SERVICES
What is a Single Case Agreement?
On occasion, Cenpatico grants exceptions, called Single Case Agreements, that allow individuals whose beneit plans do not include beneits to see a professional utilizing their beneit.
What conditions must exist for a Single Case Agreement to be made?
• An area is geographically remote for any Cenpatico provider.
• A clinical specialty is not available within Cenpatico’s network.
• Continuity of Care: If there is evidence that the individual might be a danger to him/herself or others if required to transition to an professional.
What must a professional do to obtain a Single Case Agreement?
• Review all of the information on this sheet.
• Complete this form and fax to Cenpatico Single Case Agreements at 866.374.1576. You can download a copy of this form at cenpatico.com.
Single Case Agreements are authorized on a basis.
If a Single Case Agreement is authorized, what are the terms and conditions of working with Cenpatico?
professionals must agree to the following:
• Arrangement is for a Single Case Agreement for only the individual for whom it was authorized and for only those services authorized, and there are no providers whose qualiications or specialties match those required to adequately treat the individual.
• To accept agreed upon rate & copayments, coinsurance and deductibles as payment in full.
• The enrollee cannot be billed for services that Cenpatico declines to authorize unless the individual has agreed to pay for any such services in advance and in writing.
