new patients
STEPS TO BEING SCHEDULED FOR YOUR FIRST VISIT:
Intake Process to receive a Confirmed Appointment Date and Time
No appointment is considered confirmed until the following steps are complete:
1. Intake Form Submitted
2. PNS team has received details and verified insurance coverage and guardianship
3. PNS has available openings at requested date and time
4. Patient has gathered required documentation to bring to the first scheduled appointment
1. request to be a patient: Complete prospective Form
Once we receive your New Patient Request Form, PNS will contact you to schedule your first appointment. (describe what happens at first appointment if different from 2nd appointment...)
2. required information before your first visit
You Must Provide:
1. LEGAL GUARDIANSHIP ORDER or POA paperwork, if patient over 18 years old.
2. INSURANCE COVERAGE DETAILS FROM ACCEPTED INSURANCE:
- Anthem (Commercial, HIP, Medicare/Medicaid),
- Humana (Medicare/Medicaid, Commercial),
- Optum Behavioral Health,
- UHC (Medicare/Medicaid, Commercial), Traditional Medicare and Medicaid
3. PRIOR AUTHORIZATION FROM YOUR PCP
If your insurance is not listed above, you MUST OBTAIN PRIOR AUTHORIZATION FROM YOUR PCP before your first visit in order for us to bill on your behalf.
Not Accepted: CARESOURCE
We do NOT accept CARESOURCE coverage for any reason. CARESOURCE is not accepted insurance.
LEGAL REQUIREMENTS!
2. bring these to first visit:
- ALL Insurance Cards
- State-issued ID; Valid Driver's License or Passport
- CURRENT MEDICATION list (prescribed and OTC) or MAR, including name, dose, frequency, and indication
- Documentation of existing mental health diagnoses
3. bring this paperwork:
1. BDS
ISP and/or BSP
2. IEP
3. Lab work
Most Recent
4. After Visit Summary
Most Recent
5. Prior Neuropsych Evaluations
Annual Forms
Prefer Paper Forms?
These forms require updating yearly. You can download and print the following forms.
Please bring them to your appointment or email them to info@paynenursing.com.
THANK YOU FOR YOUR COOPERATION!
These requirements help us provide the best care possible.
Payne Nursing Services
5999 West Memory Lane, Greenfield, Indiana 46140-7294
This website provides general information only and does not offer medical advice, diagnosis, or treatment. Submitting medical or personal health information should only be done through our secure HIPAA‑compliant intake form, patient portal, or telehealth platform. Use of this website does not establish a provider–patient relationship.
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