Physician Case Management Referral 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 who you believe would benefit from the Case Management Program, fill out the form below or contact the case managers by calling the Medical Department 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 Provider Procedural Manual, Section 7. Referring Physician * Physician Phone Number Member Name * Member ID * Number begins with an "H" Member's Phone Number * Eg. 447-500-0000 Physician's Email example@domain.com Please enter a diagnosis in the space provided Switch to plain text editorMore information about text formats Text format Filtered HTMLPlain text Filtered HTMLLines and paragraphs break automatically.Plain textNo HTML tags allowed.Web page addresses and e-mail addresses turn into links automatically.Lines and paragraphs break automatically. Do not put any sensitive information Enter additional comments
