Get the free Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachuse...

This form is designed to inform Tufts Health Plan of a patient's need to maintain access to care under new Continuity of Care regulations in Massachusetts.

How to fill out continuity of care review

How to fill out Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form

1. Obtain the Massachusetts Continuity of Care Review Request Form.
2. Identify the member who is requesting continuity of care.
3. Fill in the member's personal details including name, address, and insurance information.
4. Provide details about the current course of treatment, including diagnoses and medications.
5. List the healthcare providers involved in the member's care.
6. Indicate the specific services or treatments that need continuity.
7. Attach any necessary medical records or documentation to support the request.
8. Review all information for accuracy and completeness.
9. Submit the completed form to the appropriate insurance provider or plan administrator.

Who needs Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

1. Members of tiered or limited network health plans in Massachusetts who are transitioning to a new provider network.
2. Patients undergoing ongoing treatment who need to maintain continuity of care with their current providers.
3. Individuals who have recently changed health insurance plans and require evaluation for ongoing care.

For pdfFiller’s FAQs

What is Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

The Continuity of Care Review for Members of Tiered or Limited Network Plans in Massachusetts is a request form used to assess and ensure that patients receiving care from certain providers have access to necessary services, even if those providers are not part of the patient's current insurance network.

Who is required to file Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

Members enrolled in tiered or limited network health insurance plans who are seeking to continue receiving care from specific out-of-network providers or specialists may need to file this request form.

How to fill out Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

To fill out the request form, members should provide their personal information, details about their current medical providers, the services received, and the reasons for requesting continuity of care. Any relevant documentation from health care providers should also be included.

What is the purpose of Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

The purpose of the request form is to evaluate whether members can continue to receive essential medical services from their current healthcare providers, ensuring minimal disruption in their care and treatment.

What information must be reported on Continuity of Care Review for Members of Tiered or Limited Network Plans: Massachusetts Request Form?

The form requires reporting member's identity details, insurance information, a list of current healthcare providers, the types of services being rendered, and any medical necessity that supports the continuity of care request.