Coordinate non-medical, home-based interventions for Medicaid members requiring community integration. This secure 1915(i) portal facilitates referrals for stable living, behavioral health support, and long-term community success.

1915(i) Clinical Referrals

Secure Referral Interface

Encrypted HIPAA submission; clinical review within 24-48 hours

Behavioral Health Referral Form

Please complete this form to refer a member for Behavioral Health services in North Carolina.

Member First Name

Member Last Name

Date of Birth

Month

Day

Year

Medicaid ID Number

Contact Phone Number

Contact Email

Clinical Details

Primary Reason for Referral

1915i Services

Long Term Community and Supports

Current Risk Factors

Self-harm

Elopement

Aggression

Neglect/Abuse

Supporting Clinical Documentation

Upload recent Assessments, IEP, Psychological Evaluation, Certificate of Eligibility, or Discharge Summary.

Please upload relevant clinical documents in PDF or Word format.

Are you enrolled in Tailored Care Management. Yes or No

If yes Care Manager name , Phone , and Email

Is there a formal diagnosis, if yes please describe.

Does person requesting services have any behavioral concerns? (If yes, please describe):

Intake & Clinical Liaison

Phone

(919) 288-1868

Email

info@ironhorsemedical.com

Hours

Monday – Thursday, 9:00 AM – 5:00 PM EST

Friday 9:00 AM - 2:00PM

For urgent safety concerns or complex clinical questions, call Intake directly. General inquiries are processed by the Clinical Team in one business day.