The Idaho Referral Form is a document used to request the transfer of medical services from one provider to another. It can be used to refer a patient to a specialist, get additional testing or services, or to gain access to a specific treatment. There are two types of Idaho Referral Forms: the Standard Referral Form and the Electronic Referral Form. The Standard Referral Form is a paper document that must be completed by the referring provider and sent to the receiving provider. The Electronic Referral Form is an online form that can be filled out and submitted electronically. Both forms contain the same information, including the patient’s name and contact information, a description of the referral reason, and the signature of the referring provider.
Idaho Referral Form
Description
How to fill out Idaho Referral Form?
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FAQ
Any code listed may have a service limitation associated with it or need prior authorization from Medicaid or its designee. For more information, contact Gainwell Technology at 1-866-686-4272.
For questions about Food stamps, Medicaid, TAFI, or ICCP, contact the benefits customer service at MyBenefits@dhw.idaho.gov or call 877-456-1233.
Please call 1(866) 686-4272.
Contact Details Organization Type:State Medical Assistance OfficeAddress:3232 Elder Street Boise ID 837054711Information:Toll Free: (877) 456-1233 Local: (208) 334-6700 Fax: (208) 334-6912 Web Site: Hours: am-pm MT3 more rows
Call the Idaho Department of Health and Welfare's Benefits Customer Service center line: 877-456-1233.
Healthy Connections is the Idaho Medicaid program that is mandatory for most Idaho Medicaid participants. Participants will choose a primary care provider (PCP) who will coordinate their healthcare needs.
No referral or prior authorization is needed.