Medi-Cal Managed Care Referral Form for Submission
This document provides a referral form for Medi-Cal Managed Care members for both physical and behavioral health case management services. It outlines the necessary information and guidelines for the referral process. Ideal for healthcare providers needing to submit referrals for their patients.
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How do I fill this out?
To fill out the Medi-Cal Managed Care Referral Form, start by collecting all necessary information about the member. Ensure you have the details of the referrer and the member ready for submission. Follow the instructions for each section carefully to complete the form accurately.
How to fill out the Medi-Cal Managed Care Referral Form for Submission?
1
Collect necessary information about the member.
2
Complete the referrer information section.
3
Fill in the member's details including diagnosis conditions.
4
Explain the reason for the referral clearly.
5
Submit the completed form via fax or email.
Who needs the Medi-Cal Managed Care Referral Form for Submission?
1
Healthcare providers need this form to submit referrals for Medi-Cal members.
2
Case managers may use this form to ensure proper support for clients.
3
Social workers might require this to help families access necessary resources.
4
Behavioral health professionals use this to seek assistance for clients.
5
Parents or guardians of minors use this form to obtain medical support.
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What are the instructions for submitting this form?
To submit this form, fax the completed document to 866-333-4827 for physical health case management or 855-473-7902 for behavioral health case management. You may also send the form via email to bhcmreferrals@anthem.com or CAMedicaidPHCM@anthem.com. Ensure that the form is fully completed to avoid delays in processing.
What are the important dates for this form in 2024 and 2025?
Form submissions should align with operational hours. No specific important dates are indicated for 2024 and 2025 as they depend on ongoing program changes. Adherence to deadlines will ensure timely processing.
What is the purpose of this form?
The purpose of the Medi-Cal Managed Care Referral Form is to facilitate coordinated care for Medi-Cal members in need of support. It serves as a tool for healthcare professionals to ensure that members receive appropriate case management services. Through this referral process, members can access necessary medical and behavioral health resources effectively.
Tell me about this form and its components and fields line-by-line.
- 1. Referrer Information: Information about the person submitting the referral including their contact details.
- 2. Member Information: Details about the Medi-Cal member including ID, contact, and primary diagnosis.
- 3. Referral Reason: Explanation of why the referral is being made and any specific needs.
- 4. Diagnosis: Space to list the primary diagnoses/conditions of the member.
- 5. Contact Details: Primary and alternate contact numbers for communication regarding the referral.
What happens if I fail to submit this form?
Failing to submit the form correctly may result in delays in care coordination and support for the member. It's essential to provide accurate and complete information to ensure quick processing of the referral. Incomplete submissions may necessitate follow-ups that can hinder timely care.
- Delayed Care: Incomplete or missing information can lead to prolonged waiting periods for the member.
- Miscommunication: Incorrect details may result in misunderstandings between healthcare providers.
- Referral Denial: Omissions in the form may cause the referral to be rejected altogether.
How do I know when to use this form?
- 1. Physical Health Issues: Use this form when a member is facing challenges with physical health management.
- 2. Behavioral Health Needs: Applicable for cases where members need support for mental health issues.
- 3. Transition of Care: Utilize this form when members are switching care providers.
- 4. Support for Special Needs: Essential for members with unique health requirements to ensure they receive proper care.
- 5. Medication Related Challenges: Utilized when members face difficulties in obtaining necessary medications.
Frequently Asked Question
What is the Medi-Cal Managed Care Referral Form?
It is a document for healthcare providers to submit referrals for Medi-Cal members.
Who can use this referral form?
Healthcare providers, case managers, and social workers can utilize this form.
How do I fill out the form?
Collect member information, fill in the required sections and submit it via fax or email.
Can I edit the PDF?
Yes, you can edit the PDF using PrintFriendly's editing features.
How do I sign the PDF?
You can add your signature using PrintFriendly's digital signature tool.
Is the filled form shareable?
Absolutely, you can share the filled form via links or by downloading it.
What details are required on the form?
You need to provide referrer information, member details, and reasons for referral.
How long does the referral processing take?
Referral processing typically takes within three business days of submission.
What should I do if the form is incomplete?
Ensure all required fields are filled before submission to avoid delays.
Where can I submit the completed form?
You can submit the form via fax at provided numbers or through email.
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