Get the free Continuity of care request form - New Mexico Health Insurance

New Mexico Health Connections (MHC) Continuity of Care Request Form If you are receiving treatment from a provider who has terminated from the MHC network, you may request to remain temporarily with

How to fill out continuity of care request

How to fill out continuity of care request?

1. Obtain the required form: Start by locating the continuity of care request form. This can usually be found on your healthcare provider's website, or you can request a copy from their office directly.
2. Provide personal information: Fill in your personal details on the form, including your full name, date of birth, contact information, and any other required identification information.
3. Specify the reason for the request: Clearly state the reason why you need continuity of care. This could be due to a recent change in insurance provider, relocation, or any other circumstance that necessitates the transfer of your medical records.
4. List your current healthcare provider: Provide the name, address, and contact information of your existing healthcare provider from whom you are requesting the continuity of care.
5. Indicate your new healthcare provider: If you have selected a new healthcare provider, include their name, address, and contact information on the form.
6. State the duration of continuity needed: Specify the length of time for which you require continuity of care. This could range from a few months to an indefinite period, depending on your circumstances.
7. Attach any supporting documents: If you have any supporting documents, such as medical records, referral letters, or notes from your healthcare provider, attach them to the request form. These documents can strengthen your case and provide additional context for the need of continuity of care.
8. Sign and date the form: Ensure that you sign and date the request form to attest to the accuracy of the information provided.
9. Submit the form: Once you have completed the form and attached any necessary documents, submit it to your healthcare provider's designated department for processing. This could be the medical records department, patient services, or a specific continuity of care department.

Who needs continuity of care request?

1. Individuals switching healthcare providers: If you are changing your healthcare provider, whether it's due to a change in insurance or personal preference, you may need a continuity of care request. This ensures a smooth transition of your medical records and ongoing care.
2. Relocating individuals: When you move to a new area, it's essential to request continuity of care to ensure that your new healthcare provider has access to your medical history, diagnoses, and treatment plans.
3. Individuals with chronic conditions: Patients with chronic conditions who require ongoing medical care benefit from continuity of care. This allows their new healthcare provider to have a comprehensive understanding of their medical history and tailor treatment plans accordingly.
4. Recently discharged hospital patients: Patients who have been discharged from the hospital and require continuity of care should request this service to ensure a seamless transition from hospital to outpatient care.
5. Individuals seeking a second opinion: If you are seeking a second opinion from another healthcare provider, a continuity of care request allows them to review your medical history and provide an informed opinion.

By following the steps outlined in filling out a continuity of care request and understanding who needs this request, you can ensure a smooth transfer of your medical records and ongoing care.

For pdfFiller’s FAQs

What is continuity of care request?

A continuity of care request is a form submitted by a patient to ensure uninterrupted medical treatment when their healthcare provider is no longer in-network with their insurance plan.

Who is required to file continuity of care request?

Patients who are receiving ongoing treatment from a healthcare provider who is no longer in-network with their insurance plan are required to file a continuity of care request.

How to fill out continuity of care request?

To fill out a continuity of care request, patients must provide their personal information, details of their current healthcare provider, details of the ongoing treatment, and reason for requesting continuity of care.

What is the purpose of continuity of care request?

The purpose of a continuity of care request is to ensure that patients can continue receiving treatment from their current healthcare provider even if they are no longer in-network with the insurance plan.

What information must be reported on continuity of care request?

The continuity of care request must include patient's personal information, details of the current healthcare provider, ongoing treatment details, and reason for the request.

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