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Carelon Behavioral Health / Partnership HealthPlan of California Primary Care Provider (PCP) Referral Form Referral Date:___ Member Name:___MediCal CIN ID#:___DOB: ___ Parent/Guardian Name:___ Preferred
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How to fill out carelon behavioral health partnership

01
Obtain the Carelon Behavioral Health Partnership application form from their website or a local office.
02
Carefully read the instructions provided on the application form.
03
Fill out the personal information section with your name, contact details, and date of birth.
04
Provide information about your health insurance or coverage, if applicable.
05
Describe the specific behavioral health services you are seeking.
06
Include any relevant medical history or previous treatments that may help in the assessment.
07
Review the completed application for accuracy and completeness.
08
Submit the application either online or through the designated mailing address.

Who needs carelon behavioral health partnership?

01
Individuals experiencing mental health issues such as anxiety, depression, or mood disorders.
02
Families seeking support for behavioral issues in children or adolescents.
03
Adults in need of addiction treatment or substance use disorder support.
04
Individuals looking for assistance with stress management or coping strategies.
05
Anyone requiring access to specialized behavioral health services or resources.
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Carelon Behavioral Health Partnership is a collaboration focused on providing comprehensive behavioral health services, improving access to care, and enhancing the quality of mental health treatment.
Entities and providers involved in delivering behavioral health services under the Carelon model, including healthcare providers and organizations, are typically required to file the partnership.
To fill out the Carelon Behavioral Health Partnership, applicants should gather required information, complete the designated forms accurately, and submit them through the specified channels, often involving an online portal.
The purpose of the Carelon Behavioral Health Partnership is to enhance behavioral health services, promote effective treatment options, and integrate mental health care into overall health plans.
Information required includes provider details, types of services offered, patient treatment plans, billing information, and compliance with health regulations.
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