Get Gateway Referral Form
Mail to Gateway Health Plan P. O. Box 69360 Harrisburg PA 17106-9360 GATEWAY HEALTH PLAN REFERRAL FORM CAHL000705 For claims payment purposes each referral you issue requires a NEW form to be downloaded and printed. Just print complete and mail to the address on the form. PRIMARY CARE INFORMATION PCP Name PCP Address Automated telephone referrals may be done through Gateway s DIVA/EVS line at 1-800-642-3515. No referral needed when member is refe....
How It Works
How to fill out and sign referral online?
Experience all the benefits of submitting and completing forms online. With our service completing Gateway Referral Form will take a few minutes. We make that achievable through giving you access to our full-fledged editor effective at changing/correcting a document?s original text, adding special boxes, and e-signing.
Fill out Gateway Referral Form within a few minutes by using the instructions listed below:
- Select the template you want in the library of legal forms.
- Click the Get form key to open the document and begin editing.
- Submit all the necessary fields (these are yellow-colored).
- The Signature Wizard will help you add your electronic signature after you?ve finished imputing data.
- Add the date.
- Look through the entire document to make sure you?ve filled out all the information and no corrections are required.
- Hit Done and save the resulting form to your gadget.
Send your Gateway Referral Form in a digital form when you are done with filling it out. Your data is well-protected, as we keep to the newest security criteria. Join numerous happy clients that are already filling in legal forms from their houses.
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