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Transition of Care Request for New PPO Members Please complete this form if you would like Blue Cross Blue Shield of Massachusetts (BCB SMA) to consider short term coverage at the in network level

How to fill out transition of care request

How to fill out transition of care request

1. Gather all relevant medical information about the patient, such as medical history, recent diagnoses, medications, allergies, and any ongoing treatment plans.
2. Contact the receiving healthcare provider or facility and request a copy of their transition of care request form. Alternatively, check if the form is available on their website for download.
3. Carefully review the transition of care request form and ensure that all required fields are filled out accurately.
4. Fill in details about the patient, including their full name, date of birth, address, contact information, and insurance details.
5. Provide detailed information about the sending healthcare provider or facility, including their name, contact information, and any relevant identification numbers.
6. Specify the reason for the transition of care request, such as a referral to a specialist, transfer to a different healthcare setting, or discharge from a hospital.
7. Include any necessary medical documentation or test results that support the need for the transition of care.
8. Ensure that the transition of care request is signed and dated by both the patient (or their authorized representative) and the sending healthcare provider.
9. Submit the completed transition of care request to the receiving healthcare provider or facility through the preferred method, which may include fax, email, or in-person delivery.
10. Keep a copy of the filled-out transition of care request for your records.

Who needs transition of care request?

1. Patients who require a transfer of care between healthcare providers or facilities.
2. Patients who need to see a specialist recommended by their current healthcare provider.
3. Patients who are being discharged from a hospital and require follow-up care.
4. Patients with complex medical conditions who require coordinated care from multiple healthcare providers.
5. Patients who are transitioning from one healthcare setting to another, such as from a hospital to a rehabilitation facility.

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What is transition of care request?

Transition of care request is a formal notification requesting the transfer of a patient's care from one healthcare provider to another.

Who is required to file transition of care request?

The healthcare provider who will be taking over the patient's care is required to file the transition of care request.

How to fill out transition of care request?

The transition of care request form must be completed with all relevant patient information and medical history, and submitted to the previous healthcare provider.

What is the purpose of transition of care request?

The purpose of transition of care request is to ensure a smooth transfer of care for the patient and to provide the new healthcare provider with all necessary information.

What information must be reported on transition of care request?

The transition of care request must include the patient's name, date of birth, medical history, current medications, and any other relevant information for continuity of care.