Get Cfhp Texas Referral/authorization Form 2000-2026

Filling out the CFHP Texas Referral/Authorization Form online is an essential process for users who require health services authorization. This guide will provide clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the CFHP Texas Referral/Authorization Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Begin by filling out the health plan name section, including the date, and the health plan fax number.
3. In the patient info section, enter the patient’s last name, first name, middle initial, date of birth, sex, and phone number.
4. Provide the member ID number and optional social security number of the patient.
5. For the referred by section, enter the physician's personal information including last name, first name, and middle initial, along with their provider number.
6. Select the appropriate referral type: routine, urgent, emergency, out of network, revised referral, or notification only.
7. Indicate the requested start and end dates for the referral, and provide the relevant diagnosis codes.
8. Detail the scope of the referral by selecting the appropriate options including consultation, diagnostic testing, or follow-up, and specify the number of visits.
9. Provide the fax number for the contact person, their name, and phone number for reference.
10. In the specific services requested section, fill in the provider’s name, specialty type, provider/facility number, fax number, and phone number.
11. Select the referred to location type such as office, outpatient facility, inpatient, or other as applicable.
12. If applicable, fill in the date of service, and the facility name alongside the facility number.
13. Include any necessary comments or clinical history for the referral. Be sure to attach any clinical information, noting the number of pages.
14. Finally, ensure the physician signature section is signed and dated appropriately.

Take action now and complete the CFHP Texas Referral/Authorization Form online.