REFERRAL INFORMATION

When calling to make a referral, you will need to provide us with the following information:-

PART1: DEMOGRAPHIC INFORMATION AND PATIENT HISTORY
  • Patient Demographic Information: Name, Address, Phone Number and Date of Birth 
  • Social Security Number of Patient
  • Provisional Diagnosis
  • Mental Status of Patient
  • Management Concerns
  • Recent Hospitalizations: Name, Facility and Date of Service
  • Medications
  • Alcohol/Substance Abuse History
  • Current Living Situation
  • Medical Problems
 
PART2: INSURANCE INFORMATION
BHC is an Article 31 Facility. We accept patients under 21 and over 65.
  • MEDICARE: We accept all Medicare Patients. 
  • MEDICAID: We accept Medicaid for patients under 21 and over 65. Managed Medicaid is accepted for all ages. We will need the following information:-
    • Medicaid Care Number, Access Number, Sequence Number​
  • COMMERCIAL INSURANCE: We will need the following information:
    • Name of the Insured Person​
    • Social Security Number and Date of Birth
    • Name of Employer
    • Name of Insurance Carrier
    • Identification Number on the Insurance card
    • The number to call for the verification of benefits
 
PART3: CUSTODY INFORMATION
Patients under the age of 17 years, must be signed into the hospital by a parent or a court designated legal guardian. Proof of custody/guardianship is required to be presented at the time of admission.