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Dos and Don'ts

When filling out the Maryland Referral form, it’s essential to follow certain guidelines to ensure a smooth process. Here’s a handy list of things you should and shouldn’t do:

  • Do provide accurate patient information, including full name and date of birth.
  • Do specify the primary or requesting provider's details clearly.
  • Do include the reason for the referral with sufficient detail.
  • Do ensure all required signatures are present before submission.
  • Do check the referral's validity date to avoid delays.
  • Don't leave any sections blank unless instructed; if a field is not applicable, indicate that clearly.
  • Don't forget to include the patient’s contact information, including phone number.
  • Don't use abbreviations that may confuse the reviewer.
  • Don't submit the form without verifying the information for accuracy.
  • Don't assume that a referral guarantees payment; always check the member's eligibility.

Following these guidelines can help ensure that your referral is processed efficiently and effectively. Take your time to fill out the form correctly, and don’t hesitate to reach out for help if you have questions!

Misconceptions

Misconceptions about the Maryland Referral Form can lead to confusion and potential issues in the referral process. Here are seven common misconceptions clarified:

  • The referral form guarantees payment. Many believe that completing the referral form ensures that payment will be made for services. In reality, referral certification is not a guarantee of payment. Payment depends on the member's eligibility and the plan's contractual provisions.
  • All fields must be filled out for the referral to be valid. While it is important to provide as much information as possible, if a field is left blank, the form will still be processed. For instance, if the number of visits is left blank, one visit is assumed.
  • The referral is valid indefinitely. Some individuals think that once a referral is made, it remains valid forever. However, each referral has a specified validity period, which must be noted on the form.
  • Only the primary care provider can complete the referral. This is not true. Any authorized individual can complete the referral form, as long as they provide the necessary information and signatures when required.
  • ICD-9 codes are no longer relevant. Although the healthcare industry is transitioning to ICD-10, the Maryland Referral Form still requires ICD-9 codes. This is important for diagnosis and billing purposes.
  • Referrals can be made for any type of service. Referrals must be specific and related to the services desired. The form requires the reason for referral and specific procedures or treatments to be indicated.
  • Faxing the form is sufficient without confirmation. Simply faxing the referral form does not guarantee that it has been received. It is advisable to follow up with the receiving party to ensure that the referral was processed correctly.

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Key takeaways

When filling out the Maryland Referral Form, there are several important points to keep in mind to ensure a smooth process.

  • Complete All Sections: Make sure to fill out every section of the form, including patient information, provider details, and referral specifics. Incomplete forms may lead to delays.
  • Use Accurate Dates: Enter the correct date of referral and ensure that the referral is valid until the specified date.
  • Provide Detailed Information: Include a brief history, diagnosis, and any relevant test results. This information helps the consultant understand the patient's needs.
  • Specify Services Desired: Clearly indicate what services are being requested, such as consultations or specific treatments.
  • Choose the Right Place of Service: Indicate where the service will be provided, such as an outpatient center or inpatient hospital. Be specific.
  • Understand Authorization Requirements: If an authorization number is required, make sure to include it. If left blank, one visit will be assumed.
  • Signatures Matter: Ensure that the form is signed by the individual completing it and, if necessary, by an authorizing party.
  • Know Payment Conditions: Remember that referral certification does not guarantee payment. Benefits depend on the member’s eligibility and the plan’s provisions.

Following these guidelines will help streamline the referral process and improve communication between all parties involved.

Guidelines on Utilizing Maryland Referral

Filling out the Maryland Referral form is an important step in ensuring that the necessary information is communicated clearly. This form will require details about the patient, the providers involved, and the reason for the referral. Follow these steps to complete the form accurately.

  1. Date of Referral: Write the date you are filling out the form.
  2. Carrier Information: Fill in the name of the insurance carrier.
  3. Patient Information: Provide the patient's name (Last, First, Middle Initial), date of birth (MM/DD/YY), phone number, member number, and site number.
  4. Primary or Requesting Provider: Enter the name, specialty, institution or group name, provider ID number, and address (street number, city, state, zip) of the primary provider.
  5. Provider ID #2: If required, fill in the second provider's phone number and name.
  6. Consultant/Facility Provider: Write the name, specialty, institution or group name, provider ID number, and address of the consultant or facility provider.
  7. Reason for Referral: Clearly state the reason for the referral.
  8. Referral Information: Summarize the brief history, diagnosis, and test results, including the ICD-9 code.
  9. Services Desired: Check the appropriate boxes for the services required, such as initial consultation, diagnostic tests, or specific treatments.
  10. Place of Service: Indicate where the service will take place, such as an office, outpatient center, or hospital.
  11. Number of Visits: Write the number of visits authorized. If left blank, one visit is assumed.
  12. Referral Valid Until: Fill in the date until which the referral is valid.
  13. Signature: Sign the form to confirm that you have completed it.
  14. Authorizing Signature: If required, include the signature of the authorizing individual.

Once the form is filled out, it should be submitted according to the instructions provided by the carrier. Ensure that all information is accurate to avoid any delays in processing the referral.

Form Preview Example

Common mistakes

  1. Leaving out essential patient information: Failing to provide complete details like the patient's name, date of birth, and contact information can lead to delays. Ensure that all fields are filled accurately.

  2. Not specifying the reason for referral: Omitting the reason for referral can cause confusion. Clearly state the diagnosis and the services desired to help the consultant understand the patient's needs.

  3. Incorrect provider information: Providing wrong or incomplete information about the primary or requesting provider can hinder communication. Double-check the provider ID numbers and contact details.

  4. Ignoring the authorization requirements: Not including an authorization number when required can result in the referral being denied. If the form asks for it, make sure to include it or indicate that it is not applicable.

  5. Failure to sign the form: Not signing the form can invalidate the referral. Ensure that both the individual completing the form and the authorizing party sign where necessary.

Free Maryland Referral PDF

Learn More on This Form

What is the purpose of the Maryland Referral Form?

The Maryland Referral Form is designed to facilitate communication between healthcare providers regarding patient referrals. It collects essential information about the patient, the referring provider, and the consultant or facility provider. This form helps ensure that all necessary details, such as the reason for referral and services desired, are clearly documented, allowing for effective coordination of care.

What information is required to complete the Maryland Referral Form?

To complete the Maryland Referral Form, you need to provide several key pieces of information. This includes the patient's name, date of birth, and contact information. Additionally, the form requires details about the referring provider, including their name, specialty, and contact information. The consultant or facility provider's information is also necessary, along with the reason for the referral, a brief medical history, and any specific services requested. If applicable, include the authorization number and the validity date of the referral.

How long is the referral valid once submitted?

The validity of the referral is indicated on the form itself. If the "Referral is Valid Until" section is left blank, it is assumed that the referral is valid for one visit only. It is essential to check the specific instructions provided by the carrier or plan, as different plans may have varying policies regarding referral validity.

What should I do if my referral is not approved?

If a referral is not approved, it is important to review the denial reasons provided by the carrier. Often, additional information or documentation may be required. Contact the referring provider's office for guidance on how to address the issue. They can assist in resubmitting the referral or appealing the decision if necessary. Keep in mind that referral certification does not guarantee payment; eligibility on the service date and other contractual provisions apply.