Download Provider Types and Specialties

Idaho MMIS
Provider Types and Specialties
Table of Contents
Adult Residential Care ................................................................................................. 2
Agency - Institutional ................................................................................................. 2
Agency - Professional ................................................................................................. 2
Allopathic and Osteopathic Physicians ........................................................................... 2
Ambulatory Health Care Facilities ................................................................................. 7
Behavioral Health and Social Service Providers .............................................................. 7
Chiropractor Providers ................................................................................................ 8
Dental Providers ........................................................................................................ 8
Dietary and Nutritional Service Provider ........................................................................ 9
Eye and Vision Services Provider .................................................................................. 9
Group ....................................................................................................................... 9
Hospital .................................................................................................................... 9
Lab......................................................................................................................... 10
Long Term Care Facility ............................................................................................ 10
Non-Emergent Transportation Providers ...................................................................... 10
Nursing and Custodial Care Facilities .......................................................................... 10
Nursing Service Providers .......................................................................................... 10
Other Service Providers ............................................................................................ 10
Physician Assistants & Advanced Practice Nursing Providers........................................... 10
Podiatric Medicine and Surgery Service Providers ......................................................... 12
Speech, Language and Hearing Service Providers ......................................................... 12
Suppliers ................................................................................................................. 12
Technologists, Technicians & Other Tech Service Providers ............................................ 13
Therapy Services – Occupations & Physical .................................................................. 13
Transportation Services ............................................................................................ 14
July 3, 2017
Page 1 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Can be
an
ORP*
Must have
an ORP on
Claim
Adult Residential Care
Certified Family Home (CFH)
Residential Assisted Living Facility (RALF)
Agency - Institutional
Home Health
X
Hospice
X
Agency - Professional
X
Behavior Consultation/Crisis Management
Children's Service Coordination
Chore Services
DD Case Management
X
Developmental Disability Agency
X
Developmental Disability Agency - Support Only Child Services
X
Early Intervention ITP
X
Nursing Agency (PDN)
PCS/Aged & Disabled Services Agency
Public Health or Welfare (District Health Departments)
Residential Habilitation Agency
Respite Care
X
School Based Services
Supported Employment Services
Supports Brokerage-FEA
Allopathic and Osteopathic Physicians
Allergy & Immunology
X
Allergy & Immunology - Allergy
X
Allergy & Immunology - Clinical & Laboratory Immunology
X
Anesthesiology
X
Anesthesiology - Addiction Medicine
X
Anesthesiology - Critical Care Medicine
X
Anesthesiology - Hospice & Palliative Medicine
X
Anesthesiology - Pain Medicine
X
Anesthesiology - Pediatric Anesthesiology
X
Colon & Rectal Surgery
X
Dermatology
X
Dermatology - Clinical & Laboratory Dermatological Immunology
X
Dermatology - Dermatopathology
X
Dermatology - MOHS - Micrographic Surgery
X
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 2 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Dermatology - Pediatric Dermatology
Can be
an
ORP*
X
Dermatology - Procedural Dermatology
X
Emergency Medicine
X
Emergency Medicine - Emergency Medical Services
X
Emergency Medicine - Hospice & Palliative Medicine
X
Emergency Medicine - Medical Toxicology
X
Emergency Medicine - Pediatric Emergency Medicine
X
Emergency Medicine - Sports Medicine
X
Emergency Medicine - Undersea & Hyperbaric Machine
X
Family Medicine
X
Family Medicine - Addiction Medicine
X
Family Medicine - Adolescent Medicine
X
Family Medicine - Adult Medicine
X
Family Medicine - Bariatric Medicine
X
Family Medicine - Geriatric Medicine
X
Family Medicine - Hospice & Palliative Medicine
X
Family Medicine - Sports Medicine
X
General Practice
X
Internal Medicine
X
Internal Medicine - Addiction Medicine
X
Internal Medicine - Adolescent Medicine
X
Internal Medicine - Allergy & Immunology
X
Internal Medicine - Bariatric Medicine
X
Internal Medicine - Cardiovascular Disease
X
Internal Medicine - Clinical & Laboratory Immunology
X
Internal Medicine - Clinical Cardiac Electrophysiology
X
Internal Medicine - Critical Care Medicine
X
Internal Medicine - Endocrinology, Diabetes & Metabolism
X
Internal Medicine - Gastroenterology
X
Internal Medicine - Geriatric Medicine
X
Internal Medicine - Hematology
X
Internal Medicine - Hematology & Oncology
X
Internal Medicine - Hepatology
X
Internal Medicine - Hospice & Palliative Medicine
X
Internal Medicine - Infectious Disease
X
Internal Medicine - Interventional Cardiology
X
Internal Medicine - Magnetic Resonance Imaging (MRI
X
Internal Medicine - Medical Oncology
X
Must have
an ORP on
Claim
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 3 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Internal Medicine - Nephrology
Can be
an
ORP*
X
Internal Medicine - Pulmonary Disease
X
Internal Medicine - Rheumatology
X
Internal Medicine - Sleep Medicine
X
Internal Medicine - Sports Medicine
X
Internal Medicine - Transplant Hepatology
X
Neurological Surgery
X
Neuromusculoskeletal Medicine & OMM
X
Neuromusculoskeletal Medicine, Sports Medicine
X
Nuclear Medicine
X
Nuclear Medicine - In Vivo & In Vitro
X
Nuclear Medicine - Nuclear Cardiology
X
Nuclear Medicine - Nuclear Imaging Therapy
X
Obstetrics & Gynecology
X
Obstetrics & Gynecology - Bariatric Medicine
X
Obstetrics & Gynecology - Critical Care Medicine
X
Obstetrics & Gynecology - Gynecologic Oncology
X
Obstetrics & Gynecology - Gynecology
X
Obstetrics & Gynecology - Hospice & Palliative Medicine
X
Obstetrics & Gynecology - Maternal & Fetal Obstetrics
X
Obstetrics & Gynecology - Obstetrics
X
Obstetrics & Gynecology - Reproductive Endocrinology
X
Ophthalmology
X
Oral & Maxillofacial Surgery
X
Orthopedic Surgery
X
Orthopedic Surgery - Adult Reconstructive Orthopedic Surgery
X
Orthopedic Surgery - Foot & Ankle
X
Orthopedic Surgery - Hand
X
Orthopedic Surgery - Orthopedic Trauma
X
Orthopedic Surgery- Pediatric
X
Orthopedic Surgery - Spine
X
Orthopedic Surgery - Sports
X
Otolaryngology - Facial Plastic Surgery
X
Otolaryngology - Plastic Surgery within the Head & Neck
X
Otolaryngology (ENT
X
Otolaryngology (ENT - Otolaryngic Allergy
X
Otolaryngology (ENT - Otolaryngology/Facial Plastic Surgery
X
Otolaryngology (ENT - Otology & Neurotology
X
Must have
an ORP on
Claim
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 4 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Otolaryngology (ENT - Pediatric)
Can be
an
ORP*
X
Otolaryngology (ENT - Sleep Medicine)
X
Pathology - Anatomic & Clinical
X
Pathology - Anatomic Pathology
X
Pathology - Chemical
X
Pathology - Clinical & Laboratory
X
Pathology - Clinical Pathology
X
Pathology - Cytopathologist
X
Pathology - Dermatopathology
X
Pathology - Forensic Pathology
X
Pathology - Hematology
X
Pathology - Immunopathology
X
Pathology - Medical Microbiology
X
Pathology - Molecular Genetic
X
Pathology - Neuropathology
X
Pathology - Pediatric
X
Pediatrics
X
Pediatrics - Adolescent Medicine
X
Pediatrics - Allergy & Immunology
X
Pediatrics - Clinical & Laboratory Immunology
X
Pediatrics - Critical Care Medicine
X
Pediatrics - Developmental- Behavioral Pediatrics
X
Pediatrics - Gastroenterology
X
Pediatrics - Hospice & Palliative Medicine
X
Pediatrics - Infectious Diseases
X
Pediatrics - Medical Toxicology
X
Pediatrics - Neonatal/Perinatal Medicine
X
Pediatrics - Neurodevelopment Disabilities
X
Pediatrics - Pediatric Cardiology
X
Pediatrics - Pediatric Emergency Medicine
X
Pediatrics - Pediatric Endocrinology
X
Pediatrics - Pediatric Hematology-Oncology
X
Pediatrics - Pediatric Nephrology
X
Pediatrics - Pediatric Pulmonology
X
Pediatrics - Pediatric Rheumatology
X
Pediatrics - Sleep Medicine
X
Pediatrics - Sports Medicine
X
Pediatrics - Transplant Hepatology
X
Must have
an ORP on
Claim
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 5 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Physical Medicine & Rehabilitation
Can be
an
ORP*
X
Physical Medicine & Rehabilitation - Hospice & Palliative Medicine
X
Physical Medicine & Rehabilitation - Neuromuscular Medicine
X
Physical Medicine & Rehabilitation - Pain Medicine
Physical Medicine & Rehabilitation - Pediatric Rehabilitation
Medicine
X
Physical Medicine & Rehabilitation - Spinal Cord Injury Medicine
X
Physical Medicine & Rehabilitation - Sports
X
Plastic Surgery
X
Plastic Surgery - Hand
X
Plastic Surgery - Head & Neck
X
Preventative Medicine - Occupational Medicine
Preventive Medicine - Public Health & General Preventative
Medicine
X
Preventive Medicine/Occupational Environmental Medicine
X
Psychiatry & Neurology - Addiction Psychiatry
X
Psychiatry & Neurology - Bariatric Medicine
X
Psychiatry & Neurology - Child & Adolescent Psychiatry
X
Psychiatry & Neurology - Clinical Neurophysiology
X
Psychiatry & Neurology - Diagnostic Neuroimaging
X
Psychiatry & Neurology - Forensic Psychiatry
X
Psychiatry & Neurology - Geriatric Psychiatry
X
Psychiatry & Neurology - Neurology
Psychiatry & Neurology - Neurology with Special Qualifications in
Child Neurology
X
Psychiatry & Neurology - Neuromuscular Medicine
X
Psychiatry & Neurology - Psychiatry
X
Psychiatry & Neurology - Vascular Neurology
X
Radiology - Body Imaging
X
Radiology - Diagnostic Neuroimaging
X
Radiology - Diagnostic Radiology
X
Radiology - Diagnostic Ultrasound
X
Radiology - Hospice & Palliative Medicine
X
Radiology - Neuroradiology
X
Radiology - Nuclear
X
Radiology - Pediatric Radiology
X
Radiology - Radiation Oncology
X
Radiology - Radiological Physics
X
Radiology - Therapeutic Radiology
X
Must have
an ORP on
Claim
X
X
X
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 6 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Radiology - Vascular & Interventional Radiology
Can be
an
ORP*
X
Surgery
X
Surgery - Critical Care
X
Surgery - Hand
X
Surgery - Hospice & Palliative Medicine
X
Surgery - Pediatric
X
Surgery - Surgical Oncology
X
Surgery - Trauma
X
Surgery-Plastic & Reconstructive Surgery
X
Surgery-Vascular Surgery
X
Thoracic Surgery (Cardiothoracic Vascular Surgery
X
Transplant Surgery
X
Urology
X
Urology - Pediatric Urology
X
Must have
an ORP on
Claim
Ambulatory Health Care Facilities
Adult Day Care
Clinic/Center - Ambulatory Surgical
X
Clinic/Center - Birthing
X
Clinic/Center - Federally Qualified Health Center (FQHC)
Clinic/Center - Hearing & Speech
X
Clinic/Center - Indian Health Services
Clinic/Center - Physical Therapy Facility
X
Clinic/Center - Rural Health Clinics
Clinic/Center-Radiology, Mobile
X
Diagnostic Service
X
PWC Clinic
Behavioral Health and Social Service Providers
Clinical Neuropsychologist
X
Clinical Neuropsychologist - Clinical
X
Counselor
Counselor - Professional
Counselor-Addiction (Substance Use Disorder
Counselor-Mental Health
Counselor-Pastoral
Day Training/Habilitation Specialist
DD Child Independent Crisis Intervention - Professional
DD Child Independent Therapeutic Consultation
Marriage & Family Therapist
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 7 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Psychologist
Can be
an
ORP*
X
Psychologist - Addiction (Substance Use Disorder
X
Psychologist - Adult Development & Aging
X
Psychologist - Clinical
X
Psychologist - Clinical Child & Adolescent
X
Psychologist - Cognitive & Behavioral
X
Psychologist - Counseling
X
Psychologist - Family
X
Psychologist - Group Psychotherapy
X
Psychologist - Health Psychologist
X
Psychologist - Health Service
X
Psychologist - Mental Retardation & Developmental Disabilities
X
Psychologist - Prescribing (Medical
X
Psychologist - Psychoanalysis
X
Psychologist - Rehabilitation
X
Must have
an ORP on
Claim
Social Worker
X
Social Worker - Clinical
X
Chiropractor Providers
Chiropractor
Chiropractor - Rehabilitation
Chiropractor - Internist
Chiropractor - Neurology
Chiropractor - Nutrition
Chiropractor - Occupational Medicine
Chiropractor - Orthopedic
Chiropractor - Pediatric
Chiropractor - Radiology
Chiropractor - Sports Physician
Chiropractor - Thermography
Dental Providers
Dentist
X
Dentist - Endodontics
X
Dentist - Oral & Maxillofacial Pathology
X
Dentist - Oral & Maxillofacial Radiology
X
Dentist - Oral & Maxillofacial Surgeons
X
Dentist-General Practice
X
Dentist-Orthodontics & Dentofacial Orthopedics
X
Dentist-Pediatric Dentistry
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
X
Page 8 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Dentist-Periodontics
Dentist-Prosthodontics
Can be
an
ORP*
X
Must have
an ORP on
Claim
X
Denturist
Dietary and Nutritional Service Provider
Dietician Registered - Nutrition, Metabolic
X
Dietician Registered - Nutrition, Renal
X
Dietician, Registered
X
Dietician, Registered - Nutrition, Pediatric
X
PHA-Weight Management-Dietician
Eye and Vision Services Provider
Optician
Optometrist
X
Optometrist - Corneal & Contact Management
X
Optometrist - Low Vision Rehabilitation
X
Optometrist - Occupational Vision
X
Optometrist - Pediatrics
X
Optometrist - Sports Vision
X
Optometrist - Vision Therapy
Group
Multi-Specialty
Single-Specialty
Hospital
Dialysis Unit
X
General Acute Care Hospital
X
General Acute Care Hospital - Children
X
General Acute Care Hospital - Critical Access
X
General Acute Care Hospital - Rural
X
General Acute Care Hospital - Women
X
Long Term Care Hospital
X
Medicare Defined Swing Bed Unit
X
Military Hospital
X
Military Hospital - Military General Acute Care Hospital
X
Psychiatric Hospital
X
Psychiatric Unit
X
Rehabilitation Hospital
X
Rehabilitation Hospital - Children
X
Rehabilitation Unit
X
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 9 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Can be
an
ORP*
Must have
an ORP on
Claim
Lab
X
Laboratory-Clinical Medical Laboratory
Long Term Care Facility
X
Skilled Nursing Facility
Non-Emergent Transportation Providers
Agency Transportation
Commercial Transportation
Individual Transportation Provider
Nursing and Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded - ICFs/ID Private
PCS Family Alternate Care Home
PCS Family Alternate Care Home – DD Children
Nursing Service Providers
X
Diabetes Educator
Registered Nurse - Addiction (Substance Use Disorder)
Registered Nurse - Case Management
Registered Nurse - Continence Care
Registered Nurse - Hospice
Registered Nurse - Ostomy Care
Registered Nurse - Psych/Mental Health, Adult
Registered Nurse - Psych/Mental Health, Child & Adolescent
X
Registered Nurse -Independent (PDN)
Other Service Providers
Adult Companion
Crossover Only Provider
X
Driver
Home Health Aide
Licensed Midwife
Nurse's Aide
PHA-Weight Management-Personal Trainer
Technician - Attendant Care Provider
Technician - Personal Care Attendant
Physician Assistants & Advanced Practice Nursing Providers
Certified Nurse Midwife
X
Certified Registered Nurse Anesthetist
X
Clinical Nurse Specialist
X
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 10 of 15
Idaho MMIS
Provider Types and Specialties
Clinical Nurse Specialist - Adult Health
Can be
an
ORP*
X
Clinical Nurse Specialist - Chronic Care
X
Clinical Nurse Specialist - Emergency
X
Clinical Nurse Specialist - Family Health
X
Clinical Nurse Specialist - Home Health
X
Clinical Nurse Specialist - Long-Term Care
X
Clinical Nurse Specialist - Medical-Surgical
X
Clinical Nurse Specialist - Neonatal
X
Clinical Nurse Specialist - Neuroscience
X
Clinical Nurse Specialist - Occupational Health
X
Clinical Nurse Specialist - Oncology
X
Clinical Nurse Specialist - Oncology, Pediatrics
X
Clinical Nurse Specialist - Pediatrics
X
Clinical Nurse Specialist - Perinatal
X
Clinical Nurse Specialist - Perioperative
X
Clinical Nurse Specialist - Psych/Mental Health
X
Clinical Nurse Specialist - Psych/Mental Health, Adult
X
Clinical Nurse Specialist - Psych/Mental Health, Child & Adolescent
X
Clinical Nurse Specialist - Psych/Mental Health, Child & Family
X
Clinical Nurse Specialist - Psych/Mental Health, Chronically Ill
X
Clinical Nurse Specialist - Psych/Mental Health, Community
X
Clinical Nurse Specialist - Psych/Mental Health, Geropsychiatric
X
Clinical Nurse Specialist - Rehabilitation
X
Clinical Nurse Specialist - Transplantation
X
Clinical Nurse Specialist - Women's Health
X
Nurse Practitioner
X
Nurse Practitioner - Acute Care
X
Nurse Practitioner - Adult Health
X
Nurse Practitioner - Community Health
X
Nurse Practitioner - Critical Care Medicine
X
Nurse Practitioner - Family
X
Nurse Practitioner - Gerontology
X
Nurse Practitioner - Neonatal
X
Nurse Practitioner - Neonatal, Critical Care
X
Nurse Practitioner - Obstetrics & Gynecology
X
Nurse Practitioner - Occupational Health
X
Nurse Practitioner - Pediatrics
X
Nurse Practitioner - Pediatrics, Critical Care
X
Provider Type/ Specialty
Must have
an ORP on
Claim
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 11 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Nurse Practitioner - Perinatal
Can be
an
ORP*
X
Nurse Practitioner - Primary Care
X
Nurse Practitioner - Psych/Mental Health
X
Nurse Practitioner - Women's Health
X
Physician Assistant
X
Physician Assistant - Medical
X
Physician Assistant - Surgical
X
Must have
an ORP on
Claim
Podiatric Medicine and Surgery Service Providers
Podiatrist
X
Podiatrist - Foot & Ankle Surgery
X
Podiatrist - Foot Surgery
X
Podiatrist - General Practice
X
Podiatrist - Primary Podiatric Medicine
X
Podiatrist - Public Medicine
X
Podiatrist - Radiology
X
Podiatrist - Sports Medicine
X
Speech, Language and Hearing Service Providers
Audiologist
X
Audiologist - Assistive Technology Practitioner
X
Audiologist - Assistive Technology Supplier
X
Audiologist - Hearing Aid Fitter
X
Hearing Aid Vendor
X
Speech-Language Pathologist
X
Suppliers
Assistive Technology Supplier
X
Contractor-Home Modifications
Durable Medical Equipment
Durable Medical Equipment
Equipment & Supplies
Durable Medical Equipment
Equipment & Supplies
Durable Medical Equipment
Enteral Nutrition
& Medical Supplies
& Medical Supplies - Dialysis
& Medical Supplies - Oxygen
& Medical Supplies - Parenteral &
X
X
X
X
Emergency Response System Companies
Home Delivered Meals
Non-Pharmacy Dispensing Site aka: DME & Suppliers - Supplies
Only
X
Optometric Supplies
X
Pharmacy - Clinic
X
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 12 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Pharmacy - Community / Retail
Can be
an
ORP*
Must have
an ORP on
Claim
X
Pharmacy - Home Infusion Therapy
X
Pharmacy - Institutional
X
Pharmacy - Mail Order
X
Pharmacy - Specialty
X
Pharmacy Unit Dose
X
Pharmacy DME
X
PHA-Weight Management
Portable X-Ray Supplier (PXRSs)
X
Prosthetic/Orthotic Supplier
X
Technologists, Technicians & Other Tech Service Providers
Radiologic Technologist
X
Radiologic Technologist - Quality Management
X
Radiologic Technologist - Bone Densitometry
X
Radiologic Technologist - Cardiac - Interventional Technology
X
Radiologic Technologist - Cardiovascular Interventional Technology
X
Radiologic Technologist - Computed Tomography
X
Radiologic Technologist - Mammography
X
Radiologic Technologist - Radiation Therapy
X
Radiologic Technologist - Sonography
X
Radiologic Technologist - Vascular - Interventional Technology
X
Radiologic Technologist - Vascular Sonography
X
Radiology Technologist - Magnetic Resonance Imaging
X
Radiology Technologist - Nuclear Medicine Technology
X
Radiology Technologist - Radiography
X
Spec/Tech, Cardiovascular
X
Spec/Tech, Cardiovascular - Invasive Specialist
X
Spec/Tech, Cardiovascular - Sonography
X
Spec/Tech, Cardiovascular - Vascular Specialist
X
Specialist/Technologist - EEG
X
Technician, Other - EEG
X
Occupational Therapist
X
Occupational Therapist - Pediatrics
X
Physical Therapist
X
Physical Therapist - Cardiopulmonary
X
Physical Therapist - Electrophysiology, Clinical
X
Physical Therapist - Ergonomics
X
Therapy Services – Occupations & Physical
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 13 of 15
Idaho MMIS
Provider Types and Specialties
Provider Type/ Specialty
Physical Therapist - Geriatrics
Can be
an
ORP*
Must have
an ORP on
Claim
X
Physical Therapist - Hand
X
Physical Therapist - Human Factors
X
Physical Therapist - Neurology
X
Physical Therapist - Orthopedic
X
Physical Therapist - Pediatrics
X
Physical Therapist - Sports
X
Transportation Services
Ambulance
Ambulance - Air Transport
Ambulance - Land Transport
Ambulance - Water Transport
*ORP: Ordering, Referring, or Prescribing
July 3, 2017
Page 14 of 15
Idaho MMIS
Provider Types and Specialties
Section Modifications
Versio
n
7.0
Published version
6.1
Added columns for Ordering, Referring, Prescribing requirements
7/3/17
6.0
Published version
3/30/15
5.1
Updated per new provider enrollment requirements as of 4/1/15.
3/30/15
5.0
Published version
2/21/14
4.2
Added Diabetes Educator under Nursing Service Providers
2/21/14
4.1
2/21/14
4.0
Removed old AIM information and reformatted to only show HealthPAS
type and specialties. Added hyperlinks to guidelines. Renamed
document.
Published version
7/22/2013
V Gatfield
3.1
3.0
Added new specialties for Licensed Midwife and Early Intervention
Published version
7/22/2013
10/3/2011
V Gatfield
TQD
2.2
10/3/2011
J Williams
2.1
Added three specialties per CCF 10462; DD Child Indep Therapeutic
Consultation, DD Child Indep Crisis Intervention, Dev Dis Agency Support Only Child Services
Updated Suppliers specialty to Supplies only
10/3/2011
J Gillett
2.0
Published version
8/27/2010
TQD
1.1
Removed taxonomy information
8/27/2010
Molina
1.0
Initial Document
5/7/2010
Molina
July 3, 2017
Modification Description
Date
7/3/17
SME
J KennedyKing
D Baker
J KennedyKing
D Baker
TQD
J Gillett
C Taylor
TQD
C Taylor
D Baker
C Taylor
D Baker
Page 15 of 15