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BCN Behavioral Health Continuing OTR Form - e-Referral 2026
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- Click ‘Get Form’ to open the BCN Behavioral Health Continuing OTR Form in the editor.
- Begin by entering the member's name, number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for processing.
- Select the treating clinician type from the options provided (e.g., MD/DO, fully licensed psychologist). If applicable, include the supervising provider's name.
- Fill out the treatment history section by approximating the time spent in treatment with this practitioner and cumulatively over a lifetime.
- Indicate the current therapy modality being used (e.g., CBT, DBT) and provide details on any prior treatment types experienced by the member.
- Document current DSM-5 diagnosis codes and descriptions along with any significant changes in symptoms since the last review.
- Complete sections on psychiatric medication management, including prescriber details and adherence to medications. Be thorough in listing any changes since last review.
- Finally, ensure all required signatures are added before submitting. Once completed, fax the form to 1-866-364-7145 for processing.
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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.
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