Get Carecentrix Form Edrc-253

Filling out the CareCentrix Form EDRC-253 online can streamline the referral process and ensure efficient patient care. This guide provides a clear step-by-step approach to assist users in completing the form accurately.

Follow the steps to successfully complete the CareCentrix Form EDRC-253 online.

1. Press the ‘Get Form’ button to obtain the form and open it in your editing tool.
2. Begin by entering the patient demographics, including the date the referral was sent to CareCentrix, last name, first name, street address (excluding PO Box), city, phone number with area code, and alternate phone number.
3. Fill in the referral and facility information, including the admission date, contact name and facility name, facility phone number, after-hours contact, after-hours contact number, date of birth, state, zip, gender, discharge date, and fax number.
4. Indicate whether the facility is contracted with a health plan by selecting 'Yes' or 'No.'
5. In the insurance information section, provide the subscriber ID number, insurance name, group number, subscriber's last name and first name, any other insurance, and any supporting diagnosis related to post-acute care requests.
6. Specify the patient's relationship to the subscriber and attach any additional clinical information required to support the request.
7. Input the primary diagnosis that supports the requested service and the subscriber's date of birth.
8. Complete the admitting facility details, including name, phone, address, and fax, as well as the admitting facility NPI.
9. Fill out service requests, including able and willing caregiver's name and phone number, allergies, height, and weight, specifically for infusion therapy or applicable home medical equipment.
10. For infusion requests, provide details such as type of access, next dose due date/time, confirmation if it is a first-time dose (select 'Yes' or 'No'), oxygen saturation level, duration, liter flow, route, date of order, start date if different, detailed description of items needed for oxygen, and any homecare orders.
11. If applicable, address breastfeeding requests, ask if the patient has registered for delivery in the last 9 months, and include delivery information if different from the address above.
12. Complete the physician information section by listing the primary care physician's name and contact number, as well as the ordering physician's first and last name, tax ID, and NPI.
13. Finally, review all inputted information for accuracy, then save your changes, download, print, or share the form as needed.

Start completing your CareCentrix Form EDRC-253 online now for a seamless referral process.