Get Steward Referral Form - Tuftshealthplancom
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How to fill out the STEWARD REFERRAL FORM - Tuftshealthplancom online
Filling out the STEWARD REFERRAL FORM - Tuftshealthplancom is essential for efficient healthcare management. This guide provides a step-by-step approach to help you complete the form accurately and easily, ensuring all necessary information is provided for a seamless referral process.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
- In the Member Information section, fill in the Member's Name (Last, First, MI), Date of Birth, Phone Number, Member ID, and Address along with City, State, and Zip Code.
- Select the appropriate Plan from the options: Steward Employee Choice, Steward Community Choice, or FCHP Steward Community Care.
- Complete the Primary Care Provider (PCP) section by entering the PCP's Name, Office Phone Number, National Provider Identifier (NPI), Fax Number, and the Authorized Signature along with the Date.
- In the Specialist and/or Hospital Referred To section, input the Name, NPI, Specialty, Address, City, State, Zip Code, Office Phone Number, Fax Number, and Hospital Affiliation of the referred specialist or hospital.
- In the Diagnosis/Reason for Referral section, provide the reason for the referral and include any clinical documentation if referring outside of the Steward network.
- Indicate the Number of Visits Requested by checking the appropriate box for consultative opinions, second opinions, consultations, or therapy visits. Specify the number of visits where applicable.
- Review all entered information for accuracy before saving changes, downloading, or printing the form for submission.
Complete the STEWARD REFERRAL FORM online today for a prompt and efficient referral process.
The timely filing limit for Medicare reconsideration is generally 120 days from the date you receive your initial claim denial decision. This timeframe allows you to gather any necessary documents to support your case. Make sure your appeal includes a clear explanation of the reasons for your disagreement with the decision. For detailed instructions, refer to the STEWARD REFERRAL FORM - Tuftshealthplancom.
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