Get Hmsa Quest Referral

Filling out the HMSA Quest Referral form is a crucial step in ensuring that individuals receive the necessary medical services. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the HMSA Quest Referral form

1. Click the ‘Get Form’ button to access the HMSA Quest Referral form and open it for editing.
2. Enter member information in the designated fields. Include the membership number, the patient's name (last name, first name, and middle initial), date of birth, and phone number.
3. Provide referring provider information by filling in the primary care provider's last name, first name, middle initial, provider number, and phone number.
4. Fill in the details of the patient being referred. This includes their last name, first name, middle initial, provider number, and phone number.
5. In the medical/service information section, indicate the diagnosis requiring referral by entering the ICD10-CM code, service date(s), and a description of the service needed. Specify the dates for the service from and to.
6. If applicable, check the box indicating the referral is for EPSDT follow-up or related services.
7. If the referral includes enabling services for QUEST Integration members, provide necessary details such as appointment date, appointment time, total hours, and appointment address. For attendant requests, ensure the medical note is attached.
8. Specify travel details, including whether it is one-way or round-trip, lodging comments, and transportation means (ground or air) along with necessary dates and origins/destinations.
9. Fill out the attendant details, including their name, date of birth, relationship to the member, and the reason for needing an attendant.
10. Review all fields for accuracy and completeness before finalizing the form. Once you are satisfied with the information provided, you can save changes, download, print, or share the completed form.

Complete your HMSA Quest Referral online to ensure timely medical services.