Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.CREDIBLE HEALTH SOLUTIONS Mental Health Targeted Case Management (MHTCM) Two-Phase Client Intake PacketPhone: 281-339-7665 | Email: Veidusuyi@CredibleHS.com Medicaid Eligibility Verification (STAFF USE ONLY)Client/Guardian Name * *VerifiedPlan (MCO): *SuperiorAmerigroupCommunity Health ChoiceUHCOtherOther Plan (MCO): USE Other Medicaid ID Number *Effective Date *Verified by *Submit
