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Riverside Physician Network Utilization Management Subject: TERMINATED PROVIDERS×CONTINUED COVERAGE OF CARE Author: Reva Hernandez, RN Effective Date Revision Date Pages Department: Medical Management

How to fill out terminated providers continued coverage

How to Fill Out Terminated Providers Continued Coverage:

1. Obtain the necessary forms: Start by obtaining the termination notice and any other relevant forms from the health insurance provider. These forms may be available online or can be requested by contacting the provider's customer service.
2. Review the termination notice: Carefully read through the termination notice to understand the reason for termination, effective date, and any other important details. This information will be essential when completing the continued coverage forms.
3. Determine eligibility for continued coverage: Before filling out the forms, it is crucial to assess the eligibility criteria for continued coverage. The termination notice should outline the circumstances under which you might qualify for continued coverage, such as being pregnant, having a specific medical condition, or reaching a certain age.
4. Complete the continued coverage forms: Fill out the required forms with accurate and up-to-date information. Provide personal details, including your name, address, contact information, and any relevant identification or policy numbers. Additionally, complete any sections pertaining to the terminated provider, including their name, practice information, and the reason for termination.
5. Attach supporting documentation: Gather any supporting documents required to substantiate your eligibility for continued coverage. This could include medical records, doctor's notes, or any other relevant paperwork. Ensure that all documents are legible, organized, and securely attached to the forms.
6. Review and double-check: Before submitting the forms, take the time to review and double-check all the information provided. Make sure there are no errors, missing sections, or incomplete data that could potentially delay the processing of your continued coverage request.
7. Submit the forms and wait for confirmation: Once you are confident that all the forms are accurately filled out with the necessary supporting documentation, submit them to the health insurance provider. Depending on their preferred submission method, this may involve mailing, faxing, or submitting the forms online. Retain a copy of the completed forms and supporting documents for your records.

Who Needs Terminated Providers Continued Coverage?

1. Individuals with ongoing medical treatment: Those who rely on a terminated provider for ongoing medical treatment may need continued coverage. For example, patients under specialized care, receiving chemotherapy, or requiring regular visits for a chronic condition may require uninterrupted access to healthcare services.
2. Pregnant individuals in their second or third trimester: Some health insurance plans may offer continued coverage for individuals who are pregnant and in their second or third trimester at the time of provider termination. This provision ensures that pregnant individuals can continue to receive prenatal care and access maternity services.
3. Patients with critical medical conditions: Individuals with critical medical conditions, such as cancer or heart disease, may need continued coverage to ensure uninterrupted access to necessary treatments and medications. Without continued coverage, finding a new provider and undergoing the necessary evaluations can cause unnecessary delays in their care.

In conclusion, filling out terminated providers continued coverage requires obtaining the relevant forms, reviewing the termination notice, assessing eligibility, completing the forms accurately, attaching supporting documentation, reviewing everything before submission, and then waiting for confirmation. Terminated providers continued coverage may be essential for individuals with ongoing medical treatment, pregnant individuals in their second or third trimester, and patients with critical medical conditions.

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What is terminated providers continued coverage?

Terminated providers continued coverage refers to the continuation of health insurance coverage for providers who have been terminated from a network.

Who is required to file terminated providers continued coverage?

Providers who have been terminated from a network are required to file terminated providers continued coverage.

How to fill out terminated providers continued coverage?

Terminated providers can fill out the continued coverage form provided by the insurance company or network.

What is the purpose of terminated providers continued coverage?

The purpose of terminated providers continued coverage is to ensure that providers still have access to health insurance benefits after being terminated from a network.

What information must be reported on terminated providers continued coverage?

Providers must report their personal information, reasons for termination, and any additional information requested by the insurance company or network.