Imperial Health Holdings Referral Form

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Pre-Certification Referral Form - Imperial Health Plan

(8 days ago) WebPre-Certification Referral Form Please complete all sections and fax with all clinical records to support medical necessity to: Standard fax: (626)283-5021 or (888)910-4412

https://imperialhealthplan.com/wp-content/uploads/2023/05/AUTHORIZATION-REFERRAL-URGENT-FAX-UPDATE-H5496.pdf

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PRECERTIFICATION/REFERRAL REQUEST FORM - Imperial …

(6 days ago) WebPRECERTIFICATION/REFERRAL REQUEST FORM. Fax request to (806) 553-7319 or Toll-Free Fax (877) 273-3112 or to check referral status call (806) 853 …

https://imperialhealthholdings.com/pdfs/Great-States-AUTHORIZATION-REFERRAL-FORM-07.23.2019-.pdf

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Providers - Imperial Health Plan

(9 days ago) WebOur network includes a variety of physicians, specialists, hospitals, pharmacies and many other health care providers throughout multiple states and counties. If you are interested …

https://imperialhealthplan.com/california/placer/providers/

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Direct Access Referral Form - Imperial Health Plan

(4 days ago) WebX-RAYS. 73560 - 73660. Lower Leg, Ankle & Foot. 73090 - 73140 73030 - 73085 73501 - 73552 71045 - 71048 71100 - 71130. Forearm & Hand Shoulder & Upper Arm Pelvic …

https://documents.imperialhealthplan.com/2022/H2793/providers/IMPERIAL%20INSURANCE%20COMPANIES%20Direct%20Access%20Referral%20Form.pdf

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Imperial Health Plan

(8 days ago) WebFacility/Inpatient requests fax to (214) 452-1906Date Submitted STANDARD URGENTReferring ProviderPhone #Fax # REFERRAL REQUEST FORM OFFICE …

https://exchange.imperialhealthplan.com/wp-content/uploads/2022/11/Referral-Auth-Request-Form.docx

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Population Health Management Referral Form Case …

(3 days ago) WebFax form with pertinent medical records and information to: Los Angeles County: (323) 889-6575 . San Diego County: (619) 219-3302. B l u e S h i e l d of C a lif o r n i a i s an i n d …

https://www.imperialhealthholdings.com/pdfs/BSP_Health_Management_Referral_Form.pdf

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PRECERTIFICATION/REFERRAL REQUEST FORM - Imperial …

(3 days ago) WebPRECERTIFICATION/REFERRAL REQUEST FORM. Fax request to (806) 553-7319 or Toll-Free Fax (877) 273-3112 or to check referral status call 725-500-5655. …

https://documents.imperialhealthplan.com/2022/H2793/providers/Imperial+Insurance+Companies+AUTHORIZATION-REFERRAL-FORM+04.11.2022.pdf

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Provider Manual 2022

(1 days ago) WebState Department of Health Services: For verification of eligibility for Medicaid patients and managed care members, call the Automated Eligibility Verification Services (AEVS) at …

https://imperialhealthplan.com/wp-content/uploads/2023/07/Imperial-Health-Holdings-Medical-Group-Provider-Manual-2023.pdf

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Login: - Imperial Health Holdings

(1 days ago) WebAnnual Fraud Waste & Abuse Training is required for the IHHMG Network, staff, Providers and Practitioners. Reporting Fraud Waste & Abuse. Anyone can report Fraud Waste and …

https://portal.imperialhealthholdings.com/EZ-NET60/Login.aspx

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Provider Manual 2022 - Imperial Health Plan

(4 days ago) WebImperial Health Plan of California . Provider Reference Manual 2021 . Table of Contents 19.2 Direct Referral Form 19.3 Case Management Referral Form . 5 . 19.4 EZ-Net …

https://documents.imperialhealthplan.com/2022/H5496/providers/Imperial%20Health%20%20CA%20%20Provider%20Manual%20%202022.pdf

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Provider Manual 2024 - imperialhealthplan.com

(2 days ago) WebFor provider portal support and assistance, please contact (800) 830-3901. General Referral Form in Section 14 can be used and may be faxed to Imperial’s UM …

https://imperialhealthplan.com/wp-content/uploads/2024/02/Provider-Manual-2024.pdf

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Appeals and Grievances - Imperial Health Plan

(Just Now) WebPlease complete your form and mail to: Imperial Health Plan of California, Inc. PO Box 60874 Pasadena, CA 91116. You may also fax your form to: 1-626-380-9049. If you …

https://imperialhealthplan.com/california/placer/members/appeals-and-grievances/

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Imperial Dade Food Packaging Supplies Commercial Cleaning …

(9 days ago) WebMarkets We Serve. An exciting environment in which to work, learn, and grow professionally. Imperial Dade is the leading independently owned and operated distributor of food …

https://www.imperialdade.com/

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GEMS Self Referral Form 051217 - Horizon NJ Health

(4 days ago) WebPlease email your completed form to [email protected]. Please fax your completed form to 1-609-583-3039. If you have any questions, please contact …

https://www.horizonnjhealth.com/sites/default/files/GEMS_Self_Referral_Form_ENGLISH_READER.pdf

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Community Living Services Residential Application - Easterseals

(3 days ago) WebREFERRAL FORM Referral For (Please Check One) Essex 515 Valley Street, Suite 180 Maplewood, NJ 07040 973-313-0976 973-313-2479 (FAX) Residential Supportive …

https://www.easterseals.com/nj/shared-components/document-library/2020-residential-packet.pdf

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