ezrbeta.onecallcm.comOne Call: EasyReferral

It appears you are using an older version of Microsoft Internet Explorer, which is not optimal for using this web site. Here is a link to Microsoft's recommendations on browser usage: http://windows.microsoft.com/en-us/internet-explorer/download-ie. Or you might consider using Google Chrome or Mozilla Firefox if you are unable to follow Microsoft's recommendations. One Call Care Management Submit Referral We appear to have hit a technical issue with your submission. Please try submitting the data again, but before that send us the technical details of the error so we can investigate. Close Send Error Loading… Loading… Easy Referral Confirmation Summary Print This Page Done Loading… Loading… Services Physical Medicine Diagnostics Durable Medical Equipment Home Health + Complex Care Transport + Language Dental + Doctor Please correct the field(s) or click Continue to continue as-is Loading… Submitter I am Patient Adjuster Adjuster Office NCM NCM Office Referring Dr Referring Dr Office Provider of Service Other Loading… Attorney Attorney Office Employer Utilization Reviewer Utilization Reviewer Office Independent Adjuster IME Company First Name Last Name Main Phone Invalid value Ext. Fax Invalid value Cell Phone Invalid value E-mail Company Name Remember This Section Data Continue Please correct the field(s) or click Continue to continue as-is Loading… Claim/Patient Claim Patient Phone E-mail Please correct the field(s) or click Continue to continue as-is Loading… Employer Company Address Please correct the field(s) or click Continue to continue as-is Loading… Adjuster Adjuster Fax Phone E-mail Please correct the field(s) or click Continue to continue as-is Loading… Insurance Company Address Please correct the field(s) or click Continue to continue as-is Loading… Other Parties Referring Doctor Nurse Case Manager Attorney Please correct the field(s) or click Continue to continue as-is Loading… Special Instructions Please correct the field(s) or click Continue to continue as-is Loading… Attachments Files 0 Please correct the field(s) or click Continue to continue as-is Loading… Record Attachments The file type extension is not supported. Please, use files with the following extensions as attachments: .TIFF,.TIF,.PDF,.DOC,.DOCX,.RTF,.XLS,.XLSX,.PNG,.JPG,.JPEG,.GIF,.BMP,.WPD,.HTML,.HTM . Close Loading… Record Attachments The file size is too big. Maximum allowed file size is 100 MB. Close Loading… Record Attachments The file size is too small. Close Loading… Loading… Missing or incorrect data - you can’t submit this referral without addressing these: Attachments: At least one service is required Please correct the field(s) or click Continue to continue as-is Loading… Submit Referral Session Expiration Your session will expire in minutes. Please click 'Continue' to prolong session. Your session has expired. Please click 'Continue' to proceed. Continue Loading… For help contact EZRSupport@onecallcm.com The on-line services provided by One Call are for exclusive use of One Call customers and partners. © 2019 One Call. All rights reserved. Unauthorized access is strictly prohibited. Usage will be monitored....