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Care Management Program Referral Form All fields on this form are required unless unknown. Entrance into the program is dependent on member s benefits. Referral Date: Contract Number: Coverage Type:
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What is care management program referral?
A care management program referral is a request or recommendation made to a care management program to enroll an individual in their services in order to coordinate and optimize their healthcare.
Who is required to file care management program referral?
Healthcare providers, primary care physicians, or other authorized individuals are required to file a care management program referral.
How to fill out care management program referral?
To fill out a care management program referral, you need to include the individual's personal and medical information, the reason for the referral, and any relevant supporting documentation.
What is the purpose of care management program referral?
The purpose of a care management program referral is to ensure that individuals receive coordinated and comprehensive care, improve health outcomes, and reduce healthcare costs by providing necessary support and services.
What information must be reported on care management program referral?
The information that must be reported on a care management program referral includes the individual's demographics, medical history, current health status, primary care physician details, and any specific healthcare needs or concerns.
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