Get Gateway Referral Form

Filling out the Gateway Referral Form online is essential for ensuring proper processing of referrals. This guide will walk you through each section of the form step-by-step, making the process straightforward and user-friendly.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to retrieve the Gateway Referral Form and open it in your preferred online document editor.
2. In the 'Primary Care Information' section, enter the name and address of the primary care provider (PCP). Ensure that all details are accurate for verification purposes.
3. In the 'Patient Information' section, input the patient’s full name and Gateway Member ID number. Also, include the PCP's phone number and a brief diagnosis or complaint for the referral.
4. Complete the 'Specialty Provider or Facility Information' by entering the name of the specialist or facility being referred to, along with their ID numbers as required.
5. Select the appropriate services being referred to by checking the corresponding boxes. Make sure that the services align with what the patient needs.
6. The PCP must sign the form in the designated area. An unsigned form will be considered invalid for processing.
7. Finally, fill in the referral date. If the date is not present, Gateway will assign a date based on when they receive the referral at their claims office.
8. Once all fields are completed accurately, you can save your changes, download a copy, print the completed form, or share it as needed.

Complete your Gateway Referral Form online today to ensure prompt processing of your referral.