Get the free Prominence Health Plan Referral Form

Prominence Health Plan Referral Form Health & Wellness Coaching or MNT Fax referral to TeleHealth 775.770.9115 Referral Date: Referral Source: Specialist PCP Care Management Member (Self) OtherPatient

How to fill out prominence health plan referral

How to fill out prominence health plan referral

1. To fill out a Prominence Health Plan referral, follow these steps:
2. Obtain a referral form from Prominence Health Plan. This can typically be done online through their website or by calling their customer service.
3. Fill out the patient's information, such as their name, date of birth, and contact information.
4. Provide details on the healthcare provider or specialist you are seeking a referral for. Include their name, specialty, and clinic or hospital information.
5. Explain the reason for the referral and the specific medical condition or symptoms that require the specialist's expertise.
6. Attach any relevant medical documents or test results that support the need for the referral.
7. Submit the completed referral form to Prominence Health Plan either by mail, fax, or through their online portal.
8. Follow up with Prominence Health Plan to ensure that the referral has been processed and approved.
9. It is important to carefully follow the instructions provided by Prominence Health Plan to ensure a smooth referral process.

Who needs prominence health plan referral?

1. Anyone who is a member of Prominence Health Plan and requires specialized medical care or treatment from a healthcare provider or specialist that is not within their primary care network may need a Prominence Health Plan referral.
2. This typically includes situations where the member's primary care physician determines that a specialist's expertise is necessary to diagnose or treat a specific medical condition.
3. The need for a referral may vary depending on the specific health plan and coverage provided by Prominence Health Plan, so it is best to consult the plan's documentation or contact their customer service for specific eligibility and referral requirements.

For pdfFiller’s FAQs

How can I send prominence health plan referral to be eSigned by others?

Once you are ready to share your prominence health plan referral, you can easily send it to others and get the eSigned document back just as quickly. Share your PDF by email, fax, text message, or USPS mail, or notarize it online. You can do all of this without ever leaving your account.

How do I complete prominence health plan referral online?

pdfFiller has made it simple to fill out and eSign prominence health plan referral. The application has capabilities that allow you to modify and rearrange PDF content, add fillable fields, and eSign the document. Begin a free trial to discover all of the features of pdfFiller, the best document editing solution.

How do I edit prominence health plan referral on an iOS device?

You certainly can. You can quickly edit, distribute, and sign prominence health plan referral on your iOS device with the pdfFiller mobile app. Purchase it from the Apple Store and install it in seconds. The program is free, but in order to purchase a subscription or activate a free trial, you must first establish an account.

What is prominence health plan referral?

Prominence health plan referral is a process by which a member's primary care provider refers them to a specialist or other healthcare provider within the Prominence Health Plan network.

Who is required to file prominence health plan referral?

The primary care provider is typically required to file the prominence health plan referral on behalf of the member.

How to fill out prominence health plan referral?

To fill out a prominence health plan referral, the primary care provider must provide necessary information about the member's condition, reason for referral, and choice of specialist.

What is the purpose of prominence health plan referral?

The purpose of prominence health plan referral is to ensure that members receive coordinated and appropriate care from a network provider.

What information must be reported on prominence health plan referral?

Information such as member's name, ID number, diagnosis, reason for referral, and specialist information must be reported on a prominence health plan referral.