Documentation Request

First Name

Last Name

Patient Email

Patient Account

Reason for sending in the documentation

Attach a copy of the form

File Upload

Certification

Solutions

PAC: Site Optimization
PAC: Readmissions Management
Home-Based Palliative Support
Home Health
DME
Home Infusion
Sleep Management

Resources

All
Blogs
White Papers
Webinars
Press Releases

Our Company

About Us
Careers
Contact Us
Report Fraud

If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call 1-844-359-5381. If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Access our non-discrimination notice. Sign Authorization Form to Release your Protected Health Information (PHI) . Sign a Medicare Appointment of Representative form. Access the Patients Rights and Responsibilities.

Under the CareCentrix Utilization Management (UM) Program: 1) UM decision making is based on appropriateness of care & service and existence of coverage; 2) CareCentrix does not specifically reward practitioners or other individuals for issuing denials of coverage or service care; and 3) Financial incentives for UM decision makers do not encourage decisions that result in under-utilization.

CareCentrix maintains a drug-free workplace.