BCN Behavioral Health Continuing OTR Form - e-Referral 2025

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The document is a BCN Behavioral Health Continuing Outpatient Treatment Request Form, designed for clinicians to request authorization for ongoing outpatient treatment for members. It includes sections for member information, treatment history, current therapy modalities, psychiatric medication management, treatment goals, and adherence. The form emphasizes the need for detailed clinical information to support the request and outlines the process for submission via fax.

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Versions	Form popularity	Fillable & printable
2017	4.1 Satisfied (57 Votes)
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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for e referral?

If you have technical concerns, call the Web Support Help Desk at 1-877-258-3932.

What is a global referral?

Global Referral Network is Referral network in which people of the community refer each other in their company. Industry Staffing and Recruiting.

What is a referral authorization form?

A RAF is a referral form used by a Primary Care Provider (PCP) to carry out his/her case management role. It is to be used to refer assigned members for medically necessary services not generally provided by the PCP. Each RAF can only be used once and should contain diagnostic and treatment orders for only one patient.

How to get a global referral from BCN?

For members with other BCN commercial plans, global referrals are requested by primary care providers so the member can see a specialist. Primary care providers should submit global referral requests to BCN through the e-referral system. For more information, see the e-referral User Guide.

How do I submit a global referral to BCN?

Primary care providers should submit global referral requests to BCN through the e-referral system. For more information, see the e-referral User Guide. Health care providers must follow the global referral requirements that apply to the region in which their medical care group is headquartered.