Get the free Continuity of Care Request Form 3.29 - laureatemed.com
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Continuity of Care Request Formation Name: Patient DOB (MM/DD/YYY): Requesters Name: Requesting Facility/Provider: Facility Phone: Facility Fax: Laureate Medical Group Provider Name: Documentation
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What is continuity of care request?
Continuity of care request is a process by which a patient can request to continue receiving care from a specific healthcare provider even if the provider is no longer in-network with the patient's insurance plan.
Who is required to file continuity of care request?
Patients who have an ongoing treatment relationship with a healthcare provider who is leaving the network are 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 typically need to contact their insurance provider and request the necessary forms or information on how to submit the request.
What is the purpose of continuity of care request?
The purpose of continuity of care request is to ensure that patients can continue to receive care from a specific provider for a limited period of time, even if the provider is no longer in-network.
What information must be reported on continuity of care request?
The information that must be reported on a continuity of care request typically includes the patient's identifying information, the provider's identifying information, and a statement explaining why continuity of care is necessary.
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