Get Transition Of Care Continuity Of Care

This guide provides a comprehensive overview of how to fill out the Transition Of Care Continuity Of Care application online. By following these steps, you can ensure that your request for coverage is completed accurately and efficiently.

Follow the steps to complete your Transition of Care Continuity of Care application

1. Press the ‘Get Form’ button to access and obtain the Transition Of Care Continuity Of Care application in your browser.
2. Review the overview of Transition of Care and Continuity of Care. Understand the eligibility criteria and deadlines associated with your application.
3. Complete the Member Information section with accurate details such as name, UnitedHealthcare Member ID number, date of birth, and contact information.
4. Indicate your relationship to the insured individual and whether they have coverage under another health insurance carrier. Provide the carrier name if applicable.
5. Authorize the release of medical records by signing in the designated area, indicating that you consent to share necessary information with UnitedHealthcare.
6. Fill out the Care Provider Section. Ensure your health care professional provides their details, including name, National Provider Identifier, and contact information.
7. State the diagnosis, expected length of treatment, and frequency of visits. Provide any relevant information about the condition for which you are requesting Transition of Care.
8. Select the applicable description that applies to your condition, such as life-threatening condition or ongoing treatment.
9. Be mindful of the requirement to submit separate applications for multiple conditions and ensure that each is completed accurately.
10. Once the application is completed, sign and date it. If you are a guardian applying for a minor, ensure to sign accordingly.
11. Mail or fax the completed application along with relevant medical records to the address provided by UnitedHealthcare within the 30-day window.
12. Keep a copy of your submitted application for your records, and monitor for a response from UnitedHealthcare regarding your request.

Start your application for Transition Of Care Continuity Of Care today!