Get the free Referral & Precertification Request Form

Care will be directed in network. Referrals are not required for PPO Level consults. Requested Physician services CPAP supplies and DME over 250 on the EPO and PPO benefit levels. Kern Legacy Health Plan - Utilization Management Truxtun Ave 1st Floor Bakersfield CA 93301 Phone 661 868-3280 or 855 308-5547 Fax 661 868-3291 REFERRAL PRECERTIFICATION REQUEST FORM ALL BOLD FIELDS ARE REQUIRED. You will receive a determination within the number of days stated by the urgency marked Standard - 5...

How to fill out referral amp precertification request

How to fill out referral amp precertification request

1. To fill out a referral and precertification request, follow these steps:
2. Obtain the referral and precertification request form from your insurance provider or healthcare provider.
3. Fill in your personal information, including your name, contact details, and insurance information.
4. Provide the details of the healthcare provider or specialist you are requesting a referral for, including their name, contact information, and the reason for the referral.
5. If applicable, include any supporting documents such as medical records or test results that may be required for the referral.
6. Double-check all the information you have entered to ensure accuracy.
7. Submit the completed referral and precertification request form to your insurance provider or healthcare provider either in person, via mail, or electronically as per their instructions.
8. Follow up with your insurance provider or healthcare provider to confirm the status of your referral and precertification request and to obtain any necessary authorizations or approvals.

Who needs referral amp precertification request?

1. Individuals who require specialist consultations or medical services that are not covered by their primary care provider typically need a referral and precertification request. This process helps ensure that the necessary approvals and authorizations are obtained from the insurance provider before accessing specialized healthcare services.

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What is referral amp precertification request?

Referral amp precertification request is a process by which a healthcare provider seeks approval from a health insurance company before a specific medical service is provided.

Who is required to file referral amp precertification request?

Healthcare providers are required to file referral amp precertification request to obtain approval for certain medical services.

How to fill out referral amp precertification request?

To fill out a referral amp precertification request, healthcare providers must provide detailed information about the patient, the medical service being requested, and the medical necessity for the service.

What is the purpose of referral amp precertification request?

The purpose of referral amp precertification request is to ensure that the medical service being requested is medically necessary and covered by the patient's insurance plan.

What information must be reported on referral amp precertification request?

Information such as patient demographics, diagnosis, proposed treatment plan, and healthcare provider information must be reported on referral amp precertification request.