REFERRING A PATIENT TO ACTIVE LIFE

Active Life requires a physician's referral or insurance authorization to provide most services.  Our downloadable referral forms can be used if desired.  In addition to a referral, Active Life usually requires the following additional documentation to process insurance claims:

• Patient ID cards, including a State issued ID cards and insurance cards
• Patient demographic information
• Physician progress notes

Managed Care Referrals

Active Life is a preferred provider of many local IPA's and medical groups in Southern California.  Authorization coordinators from physicians and groups can usually select Active Life from an available list of providers within online referral portals when ordering services.  If this is not possible, we do suggest referral coordinators follow these suggested protocols:

• Clearly state "Requested Vendor is Active Life - Do Not Redirect"
• It may be necessary to list the closest Active Life clinic location and phone number on the auth request.
• If the procedure code (Ex. L-Code) is unknown, please contact Active Life for a suggestion or request an "EVAL" on the authorization.  If Active Life receives and EVAL, we will perform an assessment at the first patient visit but likely will not be able to dispense items because the authorization is not finalized.

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Referral Form Downloads:

All Purpose Order Form

Wound Care Order Form

Podiatry Referral Form

Compression Garment Order Form

Compression Order Form Packet