Get Preregistration Form - Tufts Health Plan

Filling out the Preregistration Form for Tufts Health Plan is a straightforward process designed to ensure that members receive the necessary care without unnecessary delays. This guide will walk you through each step of the online form to help you complete it accurately and efficiently.

Follow the steps to complete the Preregistration Form online.

1. Press the ‘Get Form’ button to access the Preregistration Form and open it for editing.
2. Begin by entering the requestor’s name at the designated field, followed by their phone number and extension if applicable.
3. Input the requestor’s fax number in the appropriate section.
4. Next, fill in the member’s name along with their ID number and date of birth.
5. Provide details about the admitting physician’s name and their contact number.
6. In the next field, enter the name of the admitting facility along with the facility's phone number.
7. Specify the inpatient admission date by entering it in the relevant field.
8. Indicate whether the member has other health insurance coverage by selecting 'Yes' or 'No'.
9. If applicable, complete the section related to prior observation date.
10. Fill in the details regarding other health insurance, including the policy name, number, and effective date.
11. For required diagnosis, enter the ICD-10 codes in the designated fields provided.
12. Similarly, fill in the ICD-10 or CPT procedure codes as needed.
13. Include the primary care provider’s name in the specified section.
14. Indicate if there is a PCP referral for this admission and specify 'Yes' or 'No'.
15. If available, provide the referral number in the specified field.
16. Include any prior authorization number when applicable.
17. Specify the requesting status by selecting from the options provided.
18. Complete the level of care section by selecting the appropriate level from the dropdown choices provided.
19. Fill in the name of the Tufts Health Plan authorizing care manager in the given field.
20. Lastly, if you have any additional comments, write them in the comments section.
21. Once all sections are filled out, review the entire form for accuracy, save your changes, and choose to download, print, or share the form as needed.

Complete your Preregistration Form online today to ensure your healthcare needs are met promptly.