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Referral Forms 

 
 
 

To submit a referral(s), please click on the appropriate link below and complete the online referral form. These forms are secure and can be submitted electronically to Rising by clicking on the "Submit" button at the bottom of the form's "Preview Form & Submit" tab.

ONLINE REFERRAL FORMS - submit to Rising electronically

Utilization Management & Care Management referrals

  • Utilization Review & Pre-Certification
  • Physician File Revew
  • Ask-A-Nurse

Pharmacy Review referral

  • Addictive Drug Evaluation
  • Complex Physician Pharmacy Review

Surgical Care Program referrals

  • Initial Surgeon Consult
  • Surgical Procedure

Medicare Set Aside (MSA) Post-Settlement Administration referrals

  • Medicare Set Aside Custodial Account - Professional Administration
  • Medical Custodial Account - Professional Administration
  • Medicare Set Aside Account - Self-Administration Support

Medical Cost Projection & Vocational referrals

  • Life Care Plan
  • Medical Cost Projection Report
  • Functional Capacity Evaluation (FCE)
  • Job Analysis
  • Labor Market Survey
  • Transferable Skills Analysis
  • Vocational Assessment
  • Vocational Rehabilitation

If you would like to learn more about any of the above services before making a referral, please submit a request for information or email info@risingms.com and we will contact you. Alternatively, please call us at 877.747.4644 with any questions.

 
 
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