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 referrals

  • Physician File ReviewURAC AccreditationSeal-2015 (2)
  • Utilization Review

Surgical Care Program referrals

  • Initial Surgeon Consult
  • Surgical Procedure

Pharmacy Review referral

  • Addictive Drug Evaluation
  • Complex Physician Pharmacy Review

Case Management referrals

  • Field Case Management
  • Telephonic Case Management

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.