Get the free HUSKY Health ProgramProvidersICM Referral Form

HUSKY Health Program ICM Referral Fax to: Intensive Care Management at 866.361.7242 Members Name:HUSKY Health ID #:DOB:Address: Phone: Home Phone:Cell Phone:Primary Language: the Best time to contact

How to fill out husky health programprovidersicm referral

How to fill out husky health programprovidersicm referral

1. To fill out the Husky Health Program Providers ICM Referral, follow these steps:
2. Gather all the necessary information about the patient, including their demographics and medical history.
3. Access the Husky Health Program online portal or obtain a physical copy of the referral form.
4. Provide the required information on the referral form, such as the patient's name, date of birth, and contact information.
5. Specify the reason for the referral and the type of specialist or service required.
6. Attach any relevant medical documents or test results that support the need for the referral.
7. Ensure that all sections of the referral form are complete and accurate.
8. Submit the referral form through the designated channel, whether it is online submission or mailing it to the appropriate address.
9. Keep a copy of the referral form for your records.
10. Follow up with the Husky Health Program to confirm receipt of the referral and to track the status of the request.
11. Communicate with the patient about the next steps and inform them about any additional information or documentation that may be required.

Who needs husky health programprovidersicm referral?

1. Individuals who meet the eligibility criteria for the Husky Health Program may need a providers ICM referral.
2. The Husky Health Program is designed to provide health insurance coverage to low-income children, pregnant women, parents and caretaker relatives, adults without dependent children, and individuals aged 65 or older who are financially eligible.
3. Therefore, those who fall under these categories and require specialized medical services or consultation from a specialist may need a Husky Health Program Providers ICM Referral.

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What is husky health programprovidersicm referral?

The HUSKY Health Program Providers ICM Referral is a process used to refer individuals for integrated care management services under the HUSKY Health Program, which provides health coverage in Connecticut for children, parents, and individuals with disabilities.

Who is required to file husky health programprovidersicm referral?

Healthcare providers who are involved in the care of HUSKY participants may be required to file the HUSKY Health Program Providers ICM Referral to access integrated care management services for their patients.

How to fill out husky health programprovidersicm referral?

To fill out the HUSKY Health Program Providers ICM Referral, providers must complete the referral form with patient details, clinical information, and the reason for the referral, ensuring all required fields are accurately filled out.

What is the purpose of husky health programprovidersicm referral?

The purpose of the HUSKY Health Program Providers ICM Referral is to identify and connect HUSKY participants to integrated care management services, ensuring they receive comprehensive and coordinated healthcare.

What information must be reported on husky health programprovidersicm referral?

The information that must be reported on the HUSKY Health Program Providers ICM Referral includes patient demographics, health concerns, medical history, and any relevant social determinants of health that could impact care.