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                Get Alohacare Referral Form
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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.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering the member ID at the top of the form. This uniquely identifies the member requiring the referral.
- 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.
- 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.
- 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.
- 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.
- Enter any relevant medical information, such as ICD-9 codes and diagnosis details, ensuring that this aligns with the services requested.
- 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.
- Fill in details regarding the facility, anticipated length of stay, and any additional coding for the services being requested.
- Complete any necessary sections regarding transportation requests if applicable, specifying the type and details of travel needed for accessing services.
- 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.
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.
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