Forms & publications

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Agreement to pay for healthcare services

This is an agreement between a “client” and a “provider” for healthcare service(s) that the Health Care Authority (HCA) will not pay.

13-879
Form

Alternate language versions:

Alien Medical Program Billing Guide (2016-10-01)

Provider billing guide

Alien Medical Program Billing Guide (2019-04-01)

Provider billing guide

Alien Medical Program Billing Guide (2020-10-01)

Provider billing guide

Alien Medical Program Billing Guide (2021-04-01)

Provider billing guide

Alien Medical Program Billing Guide (2022-01-01)

Provider billing guide

Alien Medical Program Billing Guide (2022-07-01)

Provider billing guide

Alpha-agonist age and dose

Policy

ALS - edaravone

74.50.90
Policy

Ambulance and Involuntary Treatment Act (ITA) transportation Billing Guide (2019-01-01)

Provider billing guide

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