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RIGHT CARE CASE MANAGEMENT REFERRAL FO RM REFERRING PROVIDER INFORMATION NAME: C CONTACT NAME: ADDRESS: P HONE NUMBER: NPI: TPI: MEMBER INFORMATION NAME: MEDICAID NUMBER: DATE OF B BIRTH: P HONE NUMBER:
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How to fill out referring provider information
How to fill out referring provider information
01
To fill out referring provider information, follow these steps:
02
Start by entering the referring provider's full name.
03
Then, provide the referring provider's contact information, including their phone number, email address, and physical address.
04
Next, input the referring provider's National Provider Identifier (NPI) number, if applicable.
05
If the referring provider belongs to an organization, include the organization's name and address.
06
Lastly, double-check all the information you entered for accuracy and completeness before submitting the form.
Who needs referring provider information?
01
Referring provider information is required for various purposes, such as:
02
- Referral processes in healthcare: When a patient needs specialized medical care, their primary care physician or another healthcare provider may refer them to a specialist. In this case, the referring provider's information is needed to establish a connection between the patient, the referring provider, and the specialist.
03
- Insurance claims: When submitting insurance claims, the referring provider's information may be necessary to ensure proper reimbursement and documentation.
04
- Medical records and history: Referring provider information helps in maintaining comprehensive medical records, facilitating continuity of care, and tracking referrals and treatment plans.
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What is referring provider information?
Referring provider information refers to details about the healthcare provider who referred a patient for a particular service or treatment.
Who is required to file referring provider information?
Healthcare facilities and organizations are required to file referring provider information when submitting claims for reimbursement or other purposes.
How to fill out referring provider information?
Referring provider information can be filled out by including the provider's name, National Provider Identifier (NPI), and other relevant details on the claim form or electronic submission.
What is the purpose of referring provider information?
The purpose of referring provider information is to ensure proper documentation and communication between healthcare providers involved in a patient's care.
What information must be reported on referring provider information?
The referring provider's name, NPI, specialty, and the date of referral are some of the key pieces of information that must be reported.
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