Get Alohacare Quest Referral Form 2020-2025

The Alohacare Quest Referral Form is a vital document for managing healthcare referrals and prior authorizations. This guide provides clear, step-by-step instructions to assist you in completing the form easily and accurately.

Follow the steps to fill out the Alohacare Quest Referral Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the Member ID field, enter the identification number assigned to the member seeking referral services. This number is crucial for processing the request.
3. Fill in the PCP Name field with the name of the primary care provider for the member. Ensure this information is accurate to facilitate communication.
4. Complete the Name field with the full name of the member for whom the referral is being requested.
5. Enter the member's phone number and date of birth in the corresponding fields, ensuring to provide up-to-date contact information.
6. Under the Referral section, indicate whether this is a request for in-network or out-of-network specialty care by checking the appropriate box.
7. Specify the reason for the out-of-network request only if applicable, and provide a medical necessity explanation.
8. Fill in the details of the doctor or specialist, including their name and specialty area.
9. Provide the ICD-9 codes and diagnosis related to the referral. These codes are necessary for proper medical categorization.
10. In the Request for Treatment section, indicate the type of treatment required and provide any required documentation of medical necessity.
11. If needed, fill in the details of travel requests for medically necessary services that cannot be obtained on the member's home island.
12. Review all entered information for accuracy, then save your changes, and print or download the completed form for your records.
13. Once all fields are complete and verified, you may share or submit the form as instructed.

Complete your Alohacare Quest Referral Form online today to ensure timely access to necessary healthcare services.