ERAF is a mechanism; enacted in July of 1992 by the State Legislature to shift local tax revenues from cities, counties, and special districts to a State controlled Education Revenue Augmentation Fund. The state uses this fund to reduce its obligation to the schools.

What is an eraf medical?

ERAF indicates early recurrence of atrial fibrillation.

Is partnership health plan the same as Medi-Cal?

Partnership HealthPlan of California is a non-profit community based health care organization that contracts with the State to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

What is a RAF request?

Referral Authorization Form (RAF) process: is defined as the process by which the primary care provider (PCP) submits a request to Partnership HealthPlan of California (PHC) to refer a PHC enrollee to a specialist for evaluation and/or treatment.

ERAF is a mechanism enacted in July of 1992 by the State Legislature to shift local property tax revenues from cities, counties, and special districts to an Educational Revenue Augmentation Fund. These funds are allocated by the State to schools to help meet minimum funding requirements.

What is a RAF authorization?

A RAF is a referral form used by a Primary Care Provider (PCP) to carry out his/her case management role. It is to be used to refer assigned members for medically necessary services not generally provided by the PCP. Each RAF can only be used once and should contain diagnostic and treatment orders for only one patient.

Get Partnership Raf Form

RAF NUMBER PARTNERSHIP HEALTHPLAN OF CALIFORNIA 360 Campus Lane Suite 100 Fairfield CA 94534 Referral Authorization Form RAF 707 863-4133 or 800 863-4144 707 863-4118 FAX Member Name Referred to Date of Birth ID Address Member Phone City Zip Telephone Consults must be initiated 30 days of date below. Consultants should verify PCP Payment subject to member eligibility. Approval of consultation limited to covered benefits. The consultant name must be the same as that used to bill for these services. TO BE COMPLETED BY THE REFERRING CLINICIAN Services requested Consult and / or Continuing Care 2 months Please call me when you have seen patient. up to 12 mos. I would like to receive periodic status report. from date of issue Call me if procedures or admission planned* Is requested provider contracted with PHC. This referral is If Non-Contracted provider RAF must be approved by PHC before given to member. Urgent potentially life-threatening condition* Indicated important to health not life-threatening. Reason for referral Work-up and treatment to date Include copies of lab reports imaging studies etc* Questions I need answered Primary ICD-9 /Dx Provisional Diagnosis Date of Issue Clinician Signature Print Name Send consult report to City Phone Fax Final Report please check all that apply Typed consultation note will be sent to you. My medical record note will be sent to you. I will call you to discuss case. Patient was not seen as schedulted on PHC Determination Preliminary Report Approved Redirected to Contracted Provider Denied SignatureDate Plan Signature / Print Name Distribution Copies Consultant PCP PHC Date Seen Phone No* Fax No*. Consultants should verify PCP Payment subject to member eligibility. Approval of consultation limited to covered benefits. The consultant name must be the same as that used to bill for these services. TO BE COMPLETED BY THE REFERRING CLINICIAN Services requested Consult and / or Continuing Care 2 months Please call me when you have seen patient. The consultant name must be the same as that used to bill for these services. TO BE COMPLETED BY THE REFERRING CLINICIAN Services requested Consult and / or Continuing Care 2 months Please call me when you have seen patient. up to 12 mos. I would like to receive periodic status report. from date of issue Call me if procedures or admission planned* Is requested provider contracted with PHC. up to 12 mos. I would like to receive periodic status report. from date of issue Call me if procedures or admission planned* Is requested provider contracted with PHC. This referral is If Non-Contracted provider RAF must be approved by PHC before given to member. Urgent potentially life-threatening condition* Indicated important to health not life-threatening. This referral is If Non-Contracted provider RAF must be approved by PHC before given to member. Urgent potentially life-threatening condition* Indicated important to health not life-threatening. Reason for referral Work-up and treatment to date Include copies of lab reports imaging studies etc* Questions I need answered Primary ICD-9 /Dx Provisional Diagnosis Date of Issue Clinician Signature Print Name Send consult report to City Phone Fax Final Report please check all that apply Typed consultation note will be sent to you.

How It Works

Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save

partnership raf form rating

★ ★ ★ ★ ★

★ ★ ★ ★

★ ★ ★

★ ★

★

4.8Satisfied

57 votes

How to fill out and sign PROVISIONAL online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Feel all the benefits of completing and submitting legal documents online. Using our platform filling in Partnership Raf Form only takes a matter of minutes. We make that achievable by giving you access to our full-fledged editor capable of changing/fixing a document?s initial textual content, adding special fields, and putting your signature on.

Execute Partnership Raf Form in several moments following the guidelines listed below:

Select the template you need from the library of legal form samples.
Click the Get form button to open it and start editing.
Submit the necessary boxes (they will be marked in yellow).
The Signature Wizard will help you add your electronic autograph after you have finished imputing details.
Add the relevant date.
Look through the whole document to make certain you?ve completed all the information and no corrections are needed.
Click Done and download the ecompleted form to the computer.

Send the new Partnership Raf Form in a digital form when you finish filling it out. Your data is securely protected, because we keep to the latest security requirements. Join numerous satisfied customers who are already filling in legal templates straight from their apartments.

How to edit Consultants: customize forms online

Choose a rock-solid document editing option you can rely on. Revise, execute, and certify Consultants safely online.

Too often, editing forms, like Consultants, can be a challenge, especially if you received them online or via email but don’t have access to specialized tools. Of course, you can find some workarounds to get around it, but you can end up getting a document that won't meet the submission requirements. Utilizing a printer and scanner isn’t an option either because it's time- and resource-consuming.

We offer an easier and more efficient way of completing files. A rich catalog of document templates that are easy to edit and certify, and make fillable for other people. Our platform extends way beyond a set of templates. One of the best parts of utilizing our services is that you can change Consultants directly on our website.

Since it's a web-based service, it spares you from having to download any computer software. Plus, not all corporate policies permit you to download it on your corporate laptop. Here's how you can effortlessly and safely execute your paperwork with our platform.

Hit the Get Form > you’ll be instantly taken to our editor.
As soon as opened, you can kick off the editing process.
Select checkmark or circle, line, arrow and cross and other choices to annotate your form.
Pick the date option to add a specific date to your document.
Add text boxes, pictures and notes and more to complement the content.
Utilize the fillable fields option on the right to create fillable {fields.
Select Sign from the top toolbar to create and create your legally-binding signature.
Hit DONE and save, print, and pass around or download the document.

Forget about paper and other inefficient methods for modifying your Consultants or other forms. Use our tool instead that includes one of the richest libraries of ready-to-customize forms and a powerful document editing services. It's easy and safe, and can save you lots of time! Don’t take our word for it, give it a try yourself!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Partnership Raf Form

PCP
fairfield
dx
ICD-9
clinician
redirected
ELIGIBILITY
mos
consults
periodic
referral
PROVISIONAL
consultants
consultation
imaging

If you believe that this page should be taken down, please follow our DMCA take down processhere.

VeriSign secured

#1 Internet-trusted security seal. Ensures that a website is free of malware attacks.
Accredited Business

Guarantees that a business meets BBB accreditation standards in the US and Canada.
TopTen Reviews

Highest customer reviews on one of the most highly-trusted product review platforms.