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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Coordination of Care Form

The Coordination of Care Form can be used by both Medical and Behavioral Health Practitioners to communicate information for improved coordination of care with other treating practitioners. The form is interactive and allows you to input information online, download, and print for your use. Interactive cover letters are also available for Medical and Behavioral Health practitioners.  
Coordination of Care Form
(for use by both Medical and Behavioral Health practitioners)  
Cover Letter for Medical Practitioners
(for use by Medical practitioners to communicate with Behavioral Health and other Medical practitioners). 
Cover Letter for Behavioral Health Practitioners
(for use by Behavioral Health practitioners to communicate with Medical practitioners)  
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