Get Coventry Referral Form

Completing the Coventry Referral Form online is a straightforward process that facilitates efficient communication between healthcare providers. This guide provides step-by-step instructions to help users navigate each section of the form with ease.

Follow the steps to effectively fill out the Coventry Referral Form online.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by selecting the type of request. Indicate whether it is urgent or non-urgent, as well as the service type (inpatient or outpatient).
3. Fill out the patient information section. Ensure to provide the patient's full name, identification number, any additional insurance details, and confirm job- or accident-related information if applicable.
4. In the requesting provider section, enter the requesting provider's name and NPI number. Provide a contact person and their phone number for follow-up as necessary.
5. Specify where the patient will receive services by entering the name and address of the physician, provider, or facility, along with the tentative date of service or admission.
6. In the clinical information section, provide the required ICD-9 codes and diagnosis descriptions for the patient's condition. Additionally, indicate the date of onset or injury and describe the service requested.
7. Include the necessary CPT/HCPCS codes related to the treatments requested. Ensure all relevant codes for authorization are entered accurately.
8. After completing all sections, review the form for accuracy. Once confirmed, you can save changes, download, print, or share the form as required.

Start completing your Coventry Referral Form online today for a streamlined referral process.