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Frequently needed forms for Hennepin Health providers. ... MA home care technical change request (PDF). Download ... Continuity of care form (PDF).

How to fill out continuity of care request

How to fill out continuity of care request

1. Step 1: Gather all relevant medical records and documentation that support the need for continuity of care.
2. Step 2: Obtain a continuity of care request form from your healthcare provider or insurance company.
3. Step 3: Fill out the form with accurate and detailed information. Include your personal details, healthcare provider information, and reasons for requesting continuity of care.
4. Step 4: Attach any supporting documents, such as medical reports, test results, or recommendations from your current healthcare provider.
5. Step 5: Review the filled form and attached documents for completeness and accuracy.
6. Step 6: Submit the continuity of care request form and supporting documents to your healthcare provider or insurance company, following their specified submission method.
7. Step 7: Keep a copy of the submitted form and documents for your records.
8. Step 8: Follow up with your healthcare provider or insurance company to ensure they received your request and to inquire about any additional steps or information required.
9. Step 9: Await a response from your healthcare provider or insurance company regarding the approval or denial of your continuity of care request.
10. Step 10: If approved, make arrangements with your healthcare provider for ongoing care. If denied, explore alternative options or appeal the decision if appropriate.

Who needs continuity of care request?

1. Individuals who have an existing healthcare provider and are undergoing a transition in their healthcare coverage or network.
2. Patients with ongoing medical conditions or chronic illnesses that require continuous care and follow-up.
3. Individuals receiving specialized treatments or therapies that may not be readily available within a new healthcare network.
4. Patients who have formed a long-standing trusted relationship with their current healthcare provider and wish to continue receiving care from them.
5. Individuals who have recently relocated and need assistance in transitioning their care to a new healthcare provider or network.

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What is continuity of care request?

Continuity of care request is a formal request to continue receiving medical treatment from a specific healthcare provider even if they are not in-network.

Who is required to file continuity of care request?

Patients who are receiving ongoing treatment from an out-of-network provider or specialists may be 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 usually need to provide their personal information, the name of the current healthcare provider, details of the treatment being received, and reasons for needing to continue treatment with the same provider.

What is the purpose of continuity of care request?

The purpose of continuity of care request is to ensure that patients can continue receiving uninterrupted care from a specific healthcare provider, even if they are not in-network.

What information must be reported on continuity of care request?

Information such as patient's personal details, current healthcare provider's information, details of treatment being received, and reasons for needing to continue treatment with the same provider must be reported on continuity of care request.