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The REM application must be completed and signed by the referring physician and include proper medical documentation supportive of the qualifying diagnosis. Submit completed form and all supporting clinical information to the: Maryland Department of Health REM Intake Unit 201 W. Preston Street, Room 210 Baltimore, Maryland 21201-2399 Fax 410 ...
Apply. Anyone can refer you to the program. A licensed health care provider must fill out part of the Intake form, sign, and date it. See the REM Intake and Referral Form instructions for more information. REM Intake and Referral Form . You or your provider can fax or email the completed form: Fax to 410-333-5426.
The REM Client Summary Report, report type “Active REM Clients with REM Diagnosis Expiration Between (date to date)” should pull the REM Qualifying Diagnosis from the most recent Approved REM Intake form (not the most recent Denied or in-progress form).
To apply, download and print the REM Intake Referral Form and then meet with your physician. The REM application must be completed and signed by the referring physician and include proper medical documentation supportive of the qualifying diagnosis.
22 lis 2013 · Please contact the REM Intake Unit at 1-800-565-8190 if you have any questions. PLEASE NOTE: A physician’s signature is required at the bottom of page 2. Please fax this completed form and all supporting clinical information to the REM Intake Unit at 410-333-5426. Or mail to: Maryland Department of Health & Mental Hygiene REM Intake Unit
5 sty 2024 · The Rare and Expensive Case Management (REM) Program is a case managed fee for service alternative to HealthChoice Managed Care Organization (MCO) participation for recipients with specified rare and expensive conditions.
6 kwi 2021 · An individual is eligible to participate in the REM program if the individual: (1) Is eligible for Maryland Medicaid Managed Care as specified in COMAR 10.67.02.01; (2) Has one or more of the diagnoses specified in Regulation .17 of this chapter; and
