Get Humana Referral

Filling out the Humana Referral form online can simplify the process of obtaining necessary medical referrals. This guide will take you through each section of the form, providing clear instructions to ensure you complete it accurately.

Follow the steps to complete the Humana Referral form effectively.

1. Press the ‘Get Form’ button to access the Humana Referral form and open it in your preferred editor.
2. Begin by filling out Section I: Patient Information. Ensure to provide the patient's last name, first name, middle initial, date of birth, address, city, state, zip code, and phone number. Additionally, enter the sponsor's name and social security number.
3. Proceed to Section II: Other Health Insurance. Fill in the policy holder's name, carrier name, carrier phone number, and policy ID number. Indicate if the service was approved by other health insurance by checking the relevant box.
4. In Section III: PCM Information, provide the Primary Care Manager's (PCM) contact person's name, the PCM's full name, and their signature. Include the PCM's phone number and the specialty to which the patient is referred.
5. Continue to Section IV: Referral Information. Specify the type of referral needed (e.g., evaluation only, inpatient admission) and provide details about any procedures or therapies required.
6. In Section V: Codes, enter the applicable ICD 9 diagnosis codes and/or CPT codes along with a description of the diagnosis.
7. Section VI: Clinical Information requires you to provide additional documentation to support medical necessity. Indicate whether additional information is submitted and note the service date if known.
8. Lastly, complete Section VII: Anticipated Discharge Needs by checking all applicable options related to the patient's anticipated discharge needs.
9. After ensuring all fields are completed, save your changes, and download or print the form for submission. You may then fax it to the designated number.

Complete your Humana Referral online today to ensure efficient processing.