This file combines the Blue Cross cover sheet with the Mass Collaborative form.
Please do not use this form for members in long-term care requiring physical, occupational, or speech therapy. For authorization instructions, visit Outpatient Rehabilitation Therapy.
Please do not use this form for members in long-term care requiring physical, occupational, or speech therapy. For authorization instructions, visit Outpatient Rehabilitation Therapy.
This file combines the Blue Cross cover sheet with the Mass Collaborative form.
This file combines the Blue Cross cover sheet with the Mass Collaborative form.
Please file this form one week prior to the last covered service. For more instructions on how to complete the form, refer to our Guide.