Submitting a RightCare Behavioral Health Referral/Authorization Request

To submit a referral please complete the RightCare Behavioral Health Referral/Authorization Form and upload it it, along with any supporting documentation using the form below. You will receive an e-mail confirmation upon successful submission.

This referral does not guarantee payment. Please contact health plan to verify member eligibility and covered benefits.

Note: For services requiring prior authorization, a completed form must be received by RightCare at least 2 business days before the requested services are provided. For services requiring notification, a completed form must be received by RightCare within 1 business day after the requested services are provided. Failure to timely submit a completed form to RightCare may result in the denial of days.