|
Behavioral Health Supplemental Data
|
|
Last Submission Date
|
Member ID
|
Member Name
|
Provider ID
|
Submission ID
|
Submission Type
|
Source
|
Actions
|
09/14/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001615
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/14/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001616
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/14/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001590
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001417
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001416
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001415
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001414
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001412
|
Crisis: ITA
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001411
|
Crisis: DCR
|
Provider Connect
|
Change
Copy
Delete
|
09/03/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001410
|
Crisis: DCR
|
Provider Connect
|
Change
Copy
Delete
|
09/02/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001352
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/02/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001351
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/02/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001349
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/02/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001179
|
MH: Mental Health
|
Provider Connect
|
Change
Copy
Delete
|
09/02/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001329
|
Assessment
|
Provider Connect
|
Change
Copy
Delete
|
09/01/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001324
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
09/01/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001323
|
Program End or Service Episode End Reason
|
Provider Connect
|
Change
Copy
Delete
|
09/01/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001321
|
Program End or Service Episode End Reason
|
Provider Connect
|
Change
Copy
Delete
|
09/01/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001310
|
Crisis: DCR
|
Provider Connect
|
Change
Copy
Delete
|
08/31/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001307
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
08/31/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001306
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
08/31/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001302
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
08/31/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001289
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
08/28/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000000590
|
Assessment
|
Provider Connect
|
Change
Copy
Delete
|
08/28/2020
|
987654321
|
PASLAN, SUSAN
|
123456
|
000001265
|
Authorization
|
Provider Connect
|
Change
Copy
Delete
|
|
|
|
|