508C BlueCare Plus (HMO SNP)Skilled Nursing Facility Request Fax Form BlueCare Plus (HMO SNP)Skilled 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Member Information' section. Enter the member's name, date of birth, identification number, and contact details. Ensure accuracy as this information is crucial for processing.
3. Indicate whether the member is enrolled in CHOICES or ECF CHOICES by selecting 'Yes' or 'No'. If applicable, provide details about any mental illness or intellectual disabilities.
4. In the 'Skilled Nursing Facility Information' section, input the expected admission date, facility name, and contact information. This helps streamline communication with the facility.
5. Complete the 'Ordering Physician Information' and 'Admitting Physician Information' sections with relevant physician details to ensure proper coordination of care.
6. Fill out clinical information including diagnosis, lab results, and functional status prior to admission. This data is essential for assessing care needs.
7. Review all entries for completeness and accuracy before submitting. Once finalized, fax the completed form to BlueCare Plus Utilization Management Department at 1-866-325-6698.

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