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  • Kern Family Health Care Referral/prior-authorization Form

Get Kern Family Health Care Referral/prior-authorization Form

Referral/Prior-Authorization Form Phone 661/664-5083 Fax 661/664-5190 Please Check Type PLEASE PRINT Routine Urgent/Expedited Please Check Product KFHC Medi-Cal KFHC Healthy Families GHP Member Information Complete in full Patient Name Alternate Contact Information Address City State KFHC Member ID DOB Zip Daytime Phone Age CCS Eligible Condition YES Alternate ID NO CCS Open Case Facility / Provider Information Complete in full Requesting Provider Phone Fax Provider Signature Date Requested Service s ICD9 Code s CPT Code s Patient Request Allergy Cardiology Dermatology DME Endocrine ENT GE/GI General Surgery Hem/Onc Home Health Mental Health Nephrology Facility Orthopedics Neurosurgery Pain Mgmt OB/GYN Pharmacy Ophthalmology Physical Therapy Requested Provider Podiatry Rheumatology Pulmonology Urology INFORMATION BELOW MUST BE COMPLETED TO PROCESS SERVICE REQUEST Diagnosis / Clinical Problem KFHC Date Rec d Stamp Clinical History / Date of Onset To facilitate processing of request plea....

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How to fill out the Kern Family Health Care Referral/Prior-Authorization Form online

Completing the Kern Family Health Care Referral/Prior-Authorization Form online is essential for ensuring timely processing of healthcare requests. This guide provides clear instructions on filling out each section of the form to facilitate your submission.

Follow the steps to accurately complete the form

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Indicate the type of request by selecting either 'Routine' or 'Urgent/Expedited'.
  3. Select the product type by checking one of the options: KFHC Medi-Cal, KFHC Healthy Families, or GHP.
  4. Complete the member information section by filling in the patient's name, contact information, address, city, state, KFHC Member ID number, date of birth, zip code, daytime phone, and age.
  5. Specify whether the patient has a CCS (California Children's Services) eligible condition by checking ‘YES’ or 'NO'. If yes, provide the Alternate ID number and CCS open case number.
  6. In the facility/provider information section, input the requesting provider's name, phone number, fax number, address, and signature. Also, enter the date and list the requested service(s) along with the corresponding ICD-9 and CPT codes.
  7. Select any additional requested services from the provided list, ensuring all relevant services are checked.
  8. Complete the diagnosis and clinical problem section by providing necessary details. Include clinical history and date of onset.
  9. Attach any relevant clinical documentation, such as progress notes or lab reports, which may be required to facilitate processing.
  10. After completing all sections, review the form for accuracy and completeness. Once confirmed, you can save changes, download, print, or share the filled-out form.

Complete your forms online for efficient health care processing.

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The rapid re-housing program in Bakersfield, CA, aims to quickly transition individuals and families from homelessness to permanent housing. This program offers a variety of resources, including financial assistance and housing services. If you need help accessing these resources, the Kern Family Health Care Referral/Prior-Authorization Form can guide you through the process.

Kern Family Health Care does provide assistance with rent in certain cases, primarily through referrals to housing programs. They focus on supporting members facing financial difficulties regarding their housing situations. Connecting with them through the Kern Family Health Care Referral/Prior-Authorization Form can help you navigate available options effectively.

To access Kern Family Health Care, you can enroll through your local agency, or you may qualify via Medi-Cal. Once enrolled, utilize the Kern Family Health Care Referral/Prior-Authorization Form to access specific services or treatments. This process ensures you receive the coverage you need in a timely manner.

If you need a new Kern Family Health Care card, you should contact their customer service right away. You can request a replacement card online, over the phone, or by visiting a local office. Typically, they will ask for some identifying information to verify your account. Having your Kern Family Health Care Referral/Prior-Authorization Form handy can expedite this process if your card is related to specific health services.

Kern Family Health Care does not directly provide housing services, but they can connect you with resources that assist with housing needs. They focus primarily on healthcare, but understanding your overall situation is part of holistic care. By accessing their services, you may receive referrals to community programs that address housing stability. If you need assistance, filling out a Kern Family Health Care Referral/Prior-Authorization Form can sometimes unlock further support options.

Kern Family Health Care and Medi-Cal are related but not the same. Medi-Cal is California's Medicaid program, providing health coverage for eligible individuals, while Kern Family Health Care is a managed care plan under Medi-Cal. Both programs aim to provide affordable healthcare, but Kern Family Health Care operates its own network of services. Understanding the distinctions can help you navigate the Kern Family Health Care Referral/Prior-Authorization Form in relation to Medi-Cal services.

Enrollment in Kern Family Health Care is easy and straightforward. You can either enroll online through their website or in person at designated enrollment sites within your local community. When enrolling, be prepared to provide your identification and income details. To complete your enrollment, you may also need to fill out a Kern Family Health Care Referral/Prior-Authorization Form for specific services and needs.

Kern Family Health Care operates as a Health Maintenance Organization (HMO). This means that care is usually provided through a network of doctors and hospitals that have contracts with the health plan. By choosing an HMO, you may have lower out-of-pocket costs, but you must select a primary care physician who will coordinate your care, including the necessary Kern Family Health Care Referral/Prior-Authorization Form when required.

To apply for Kern Family Health Care, you need to visit your local enrollment site or apply online through the official Kern Health Systems website. You will need to provide required personal and financial information. Once your application is submitted, it will be reviewed to determine eligibility. If you need further assistance in filling out the Kern Family Health Care Referral/Prior-Authorization Form, consider using uslegalforms for a streamlined process.

Kern Family Health Care does cover emergency room visits if they are medically necessary. In such situations, it's critical to seek immediate care. To streamline the process, especially for follow-up care, you might need to fill out the Kern Family Health Care Referral/Prior-Authorization Form.

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Fill Kern Family Health Care Referral/Prior-Authorization Form

Report of health examination for school entry. UM prior authorization request form. Search Form Prior Authorization List The Footer in the above PDF contains the date and time the list was generated. Through the Member Handbook, the Plan informs Members of their rights to access family planning services and that they do not require prior authorization. Ambulance and Air Transportation modalities DO require KFHC referral submission to Utilization. Management for review. View the links below to find member forms you can download, making it quicker to take action on claims, reimbursements and more. To download a prior authorization form for a non-formulary medication, please click on the appropriate link below. This document lists all the procedures and services that do not require a Prior Authorization while seeking services through a contracted provider. As a Kern Family Health Care (KFHC) member, you can connect directly to an Enhanced Care Management provider to make a care plan for you.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232