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  • Alohacare Referral Form

Get Alohacare Referral Form

REFERRAL/PRIOR AUTHORIZATION/NOTIFICATION REQUEST FORM Prior Authorization Line: (808) 973-1657 1357 Kapiolani Blvd, Ste 1250, Honolulu, HI 96814 Ph: 973-1650 (Oahu) or 1-800-434-1002 (NI) Fax: 973-0676.

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How to fill out the Alohacare Referral Form online

This guide provides clear, step-by-step instructions on completing the Alohacare Referral Form online. By following these guidelines, you can ensure that all necessary information is correctly provided for efficient processing.

Follow the steps to fill out the Alohacare Referral Form accurately.

  1. Click 'Get Form' button to obtain the form and open it in the editor.
  2. Begin by entering the member ID at the top of the form. This uniquely identifies the member requiring the referral.
  3. Fill in the primary care provider's (PCP) name in the designated field. This section is crucial for linking the referral to the correct provider.
  4. Provide the patient's name along with their phone number and date of birth in the respective fields. Accurate identification is necessary to prevent any processing issues.
  5. Indicate the referral category by checking the appropriate box. You should also complete the referral effective date range; if this is left blank, the referral will be effective for one year from the request date.
  6. List the doctor's name and specify whether they are in-network or out-of-network. For out-of-network requests, provide the reason based on medical necessity.
  7. Enter any relevant medical information, such as ICD-9 codes and diagnosis details, ensuring that this aligns with the services requested.
  8. If applicable, complete the request for treatment requiring prior authorization, and attach any necessary clinical notes or documentation that validate the medical need for services.
  9. Fill in details regarding the facility, anticipated length of stay, and any additional coding for the services being requested.
  10. Complete any necessary sections regarding transportation requests if applicable, specifying the type and details of travel needed for accessing services.
  11. Finally, review all sections for accuracy, and ensure you have signed where indicated. Users can then save changes, download, print, or share the completed form.

Begin your process by filling out the Alohacare Referral Form online today.

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Questions & Answers

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Yes, AlohaCare is a managed care organization that provides Medicaid services in Hawaii. It offers health coverage to eligible residents, ensuring they receive the care and support needed. The AlohaCare Referral Form is instrumental in facilitating the referral process and ensuring that members can access appropriate healthcare services.

HMSA, or Hawaii Medical Service Association, is not Medicaid itself but offers health insurance plans that can include Medicaid coverage. It provides a range of health plans to residents of Hawaii, often partnering with Medicaid programs. Individuals seeking assistance can use the AlohaCare Referral Form for streamlined access to various health services.

In Hawaii, Medicaid is called Med-Quest. This program offers medical coverage for eligible low-income individuals and families. Enrollment in Med-Quest can be assisted through the AlohaCare Referral Form, which helps facilitate access to needed services.

An example of referring a patient is when a primary care physician identifies a patient with a specific issue that requires a specialist. For instance, if a patient shows signs of diabetes, the physician may complete a referral to an endocrinologist. This process is documented through the AlohaCare Referral Form, which provides all necessary information for the specialist.

Eligibility for AlohaCare Hawaii includes individuals who qualify for Medicaid or are low-income residents needing health services. This program focuses primarily on members of the community who require support for their health needs. Utilizing the AlohaCare Referral Form can help navigate the benefits available through this service efficiently.

Filling out a referral form requires accuracy and attention to detail. Start by entering the patient's information and reason for the referral. Ensure you include the details of the provider you are referring to and any relevant clinical notes. The AlohaCare Referral Form is a user-friendly option that streamlines this entire process, making it efficient for both providers and patients.

The best health insurance in Hawaii often depends on individual needs, but AlohaCare is highly regarded for its comprehensive coverage options. It provides plans that are designed to serve a diverse population, including those eligible for Medicaid. By comparing different plans and utilizing the AlohaCare Referral Form, you can identify which insurance meets your requirements.

A patient referral includes key details such as the patient's demographics, medical history, and the purpose of the referral. It also specifies the specialist or provider being referred to, along with their contact information. This information is crucial for continuity of care and is effectively captured through the AlohaCare Referral Form.

Filling out a patient referral form involves several key steps. First, gather the patient's personal and medical information in advance. Next, complete sections regarding the referring provider and the specialty care required, and conclude with your signature and date. Utilizing the AlohaCare Referral Form simplifies this process, allowing for efficient and accurate entries.

To write a referral for a patient, start by providing the patient's information, including their full name and date of birth. Outline the reason for the referral clearly, emphasizing why the patient needs specialized care. Finally, include essential details about the referred provider, such as their name, address, and contact information, as this ensures a smooth transition for the patient leveraging the AlohaCare Referral Form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232