Get Humana Referral Authorization Forms Printable

Filling out the Humana Referral Authorization Form is an important step in ensuring that patients receive the necessary referrals for medical services. This guide provides clear and concise instructions on how to accurately complete the form online, making the process easier for users.

Follow the steps to complete the Humana Referral Authorization Form accurately

1. Press the ‘Get Form’ button to access the Humana Referral Authorization Form and open it in your chosen document editor.
2. Begin filling out the form by entering the Sponsor's Social Security Number (SSN) in the designated field.
3. Provide the Patient's Name clearly in the respective space to ensure accurate identification.
4. Input the Patient's Date of Birth (DOB) using the MM-DD-YYYY format as specified in the form.
5. Fill in the Patient's Zip Code, followed by their Address, City, and State details for proper documentation.
6. Indicate whether the patient has Other Health Insurance by selecting ‘Yes’ or ‘No.’ If applicable, provide the carrier name and Policy Number.
7. Enter the Date of Service, ensuring it is formatted correctly.
8. Select the Provider or Setting by marking one of the options provided (e.g., Physician's Office, Outpatient Facility).
9. If available, provide the Point of Contact details, including their Phone number.
10. Detail the Type of Service required, noting the specialty, such as Office Visit, Surgical/Diagnostic Procedure, or Home Health.
11. For Inpatient Admission, specify the type (e.g., Acute Care, Rehab) and provide a diagnosis code if applicable.
12. Document the Presenting Symptoms or Reason for Referral in the space provided.
13. Include any Pertinent History, Findings, and Special Situations that are relevant to the patient's case, especially known discharge needs for inpatient admissions.
14. Once all fields are complete, save your changes, and download or print the form for submission as needed.

Complete your Humana Referral Authorization Form online today for efficient processing.