How to refer a member to Apple Community Health Services

The three routes in

1. Phone. This is the working route and the fastest one. Intake takes the referral verbally, opens the record during the call, and tells you on the call what is missing. Business hours and the number are in the contact details on this site; do not rely on a number found elsewhere online, because several outdated ones are still in circulation on directory listings.

2. Secure online form. A referral describes an identifiable person’s health. That is protected health information, and it must be collected on a platform whose vendor has signed a business associate agreement – never on general website infrastructure, where it would land in logs and backups that are not built to hold it. The form goes live once that vendor arrangement is in place. Until then, use phone or fax.

3. Fax. Appropriate for sending documents you already hold – a DMA-6, a discharge summary, a face sheet, a completed level-of-care form. Fax the packet and call, or call and then fax; a faxed packet with no accompanying call sits without a named contact on our side.

Not a route: ordinary email. Do not send member names, dates of birth, Medicaid numbers, diagnoses or clinical documents by regular email, and do not attach them to a calendar invite or a shared drive link. If email is the only channel you have, send a message asking for a call back and put no member detail in it.

The sequence

1. Decide the referral is for waiver case management, not for a service. A case management agency arranges, coordinates and monitors. It does not send an aide. If the member’s need is a shift on Thursday, the referral you want is to a personal support or home care provider, and the waiver referral runs alongside it.
2. Gather what you have. Identifiers and Medicaid status, current functional deficits, the clinical summary, discharge or transition context, and who holds authority to consent. The documentation checklist sets out each item and what its absence costs in time.
3. Call. Give the member’s name and date of birth first – that is what the record is opened against. Then the callback number for the member or their representative. Then everything else.
4. Say what your deadline is, if you have one. A discharge date, a facility Medicaid end date, a caregiver who is leaving the household on a known date. It changes the order in which work is done, and it changes what ACHS tells the family about bridging the gap.
5. Fax the documents you already hold rather than describing them.
6. Note what you were told on the call. Intake will tell you what is missing and what happens next. Write it into your own record so the next person on your side does not re-refer.

What happens if the packet is incomplete

The referral is still opened. Missing items are chased after intake, not before it. A referral held back for two weeks while somebody’s office locates a DMA-6 is two weeks of clock that cannot be recovered, and the DMA-6 can be obtained during the process.

Two exceptions worth knowing. Without a working phone number for the member or an authorized representative, nothing can move at all – a name and a diagnosis with no reachable person is not a workable referral. And where the person has never been screened by the Area Agency on Aging / ADRC, that screening is a required step and cannot be substituted by a provider’s own intake.

Referring on behalf of someone already served by another agency

Members have the right to choose their case management agency and to change it. If a member or family asks about changing, answer honestly and describe their options. ACHS does not run outreach aimed at other agencies’ existing clients, and no gift, gratuity, bonus or payment is offered to anyone for a referral in any form. Georgia DCH rules prohibit both, and a referral relationship that depends on either is not one worth having.