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

Rising_URAC%20Seal_jpgUtilization Management referrals

  • Physician File Review
  • Utilization Review

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 referrals

  • Life Care Plan
  • Medical Cost Projection Report

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 and we will contact you.