Friday, May 18, 2012
   
Text Size
Physician Case Management Referral

The Health Plan has registered nurses that are certified case managers to coordinate health care services for members with catastrophic illnesses, injuries or behavioral health problems. If you have a patient you believe would benefit from the Case Management Program, fill out the form below or you can contact the case managers by calling the Medical Department at 740.695.7644 or 740.695.7643 and toll-free at 1.800.624.6961, ext. 7644 or 7643.

Further explanation of The Health Plan Case Management Program can be found in the Practitioner Procedural Manual, Section 7.

Fields listed with an "*" are required.

Required *

Please type the referring Physician's Name

Please type your Member Name

Health Plan ID Number must be nine characters and begin with an H

Please include your phone number. Do not include spaces

  Refresh Captcha