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NEW KAISER PERMANENT REFERRAL FORM Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. Referral Summary Member Name: HENRY A. MEMBER 123 ANY STREET ANTON, USA 1234 December 10, 2004, Member

How to fill out external referral and authorization

How to fill out external referral and authorization:

1. Obtain the necessary referral form: Begin by obtaining the external referral and authorization form from the appropriate source, such as your insurance company or healthcare provider.
2. Fill in personal information: Start by providing your personal information, including your full name, date of birth, address, contact details, and insurance information. Ensure that all the information is accurate and up-to-date.
3. Provide the referring healthcare provider's information: Next, fill in the details of the healthcare provider who is referring you for external services. Include their name, address, contact information, and any relevant identification numbers.
4. Specify the requested service: Clearly state the specific service or treatment that you are seeking external referral and authorization for. Provide details such as the type of procedure, the reason for referral, and any specific healthcare professional or facility you prefer.
5. Include supporting documents: If there are any supporting documents that are required to support your referral request, make sure to attach them. These may include medical reports, test results, or any other relevant documentation.
6. Obtain the necessary signatures: Once you have completed filling out the referral and authorization form, ensure that you sign and date the document. If required, also have the referring healthcare provider sign and provide any additional information or signatures as necessary.
7. Submit the form: After completing all the necessary sections and obtaining the required signatures, submit the referral and authorization form to the appropriate party. This could be your insurance company, your primary care physician, or the relevant department or healthcare facility.

Who needs external referral and authorization?

1. Individuals seeking specialized medical treatments or procedures that are not available within their primary healthcare provider's network may require an external referral and authorization.
2. Patients who are referred to a specialist by their primary care physician often need external referral and authorization to ensure coverage for the recommended treatment or procedure.
3. People with specific insurance plans that require referral and authorization for certain medical services may also need to go through this process.

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What is external referral and authorization?

External referral and authorization is a process where a healthcare provider requests approval from a third-party payer before providing certain services or procedures to a patient.

Who is required to file external referral and authorization?

Healthcare providers are required to file external referral and authorization before providing specific services or procedures that require approval from a third-party payer.

How to fill out external referral and authorization?

To fill out external referral and authorization, healthcare providers need to submit the necessary information and documentation to the third-party payer for approval.

What is the purpose of external referral and authorization?

The purpose of external referral and authorization is to ensure that healthcare services or procedures are medically necessary and meet the criteria set forth by the third-party payer.

What information must be reported on external referral and authorization?

External referral and authorization forms typically require information such as patient demographics, medical history, diagnosis, treatment plan, and provider information.