Get Case Management Referral Form - Bcbstx

Filling out the Case Management Referral Form - BCBSTX online is an important step for users seeking case management or continuity of care services. This guide provides a comprehensive walkthrough to ensure you accurately complete each section of the form.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the member's name in the designated field. Ensure this matches the official records for accuracy.
3. Input the member's date of birth. Use the format specified on the form to avoid confusion.
4. Provide the member's phone number in the next field. This is critical for follow-up communication.
5. Enter the member ID number. Double-check that this number is correct as it helps in identifying the member's case.
6. Specify the date you are referring the member to case management. This indicates when the referral is initiated.
7. Complete the section with the name of the person submitting the referral. This identifies the individual responsible for the referral.
8. Fill in the phone number of the person submitting the referral for communication purposes.
9. Explain the reason for the case management referral clearly. Choose from the provided options or specify if it is a unique circumstance.
10. If applicable, complete the health assessment questionnaire by checking the relevant boxes.
11. Indicate any catastrophic conditions, chronic conditions, or psychosocial factors that may affect the member's care.
12. State whether the member needs continuity of care services due to changes in their physician or insurance.
13. Attach any relevant comments that may help case management understand the context of the referral better.
14. Confirm whether medical records are attached to the referral by selecting 'Yes' or 'No'.
15. Once all sections are completed, review the form for accuracy and completeness.
16. Save your changes, download, print, or share the form as needed to finalize the referral process.

Complete the Case Management Referral Form - BCBSTX online today to ensure timely assistance.