Dec. 23, 2019
Coordinating care between behavioral health and medical providers helps deliver the best care for our members. Our surveys consistently show providers appreciate care coordination. Consulting and referring providers should share information such as diagnoses, medications, treatment plans and recommendations to ensure care is appropriately coordinated. We’ve provided a simple form to help providers request information from each other.
Be sure members sign a release to allow you to share information with other providers before using this form.
Coordination of Care Form
The form is useful for both referring and consulting providers. To request patient visit information from a consulting provider, complete the Patient Information and Referring Provider sections before sending it to the consulting provider. The consulting provider can use the form to communicate information about the visit to the referring provider. Do not send this form to us. It is for your use with other providers only.
Need help finding a Behavioral Health provider?
Call the number on the back of the member’s ID card to find outpatient providers or behavioral health facilities. You can also search for providers with our online Provider Finder®.
Have a member with complex health needs?
Additional support and resources from a behavioral health or medical clinician are available. Call the number on the back of the member’s ID card to refer members to Case Management and learn about other resources.