- How do I refer a patient to a participating specialist?
- How do I refer a patient to a non-participating specialist?
- Can another primary care provider (PCP) see my patient?
- Is prior authorization required for mental health outpatient visits?
- Who is responsible for obtaining authorization for procedures performed by a specialist?
- How are approved requests for authorization confirmed?
- How long does it take to get an authorization approved?
- May I submit a request for authorization after a procedure has been performed?
Q. How do I refer a patient to a participating specialist?
A. Primary care physicians (PCP) and other participating specialists may direct members to any participating specialist. A formal referral is not necessary.
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Q. How do I refer a patient to a non-participating specialist?
A. Complete the Request for Authorization form or contact Health Care Services to discuss the referral.
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Q. Can another primary care provider (PCP) see my patient?
A. Yes. In order to meet the needs of our members, our plans allow for this kind of flexibility.
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Q. Is prior authorization required for mental health outpatient visits?
A. No.
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Q. Who is responsible for obtaining authorization for procedures performed by a specialist?
A. The specialist that will be performing the procedure is responsible for obtaining authorization by completing a Request for Authorization form. The primary care physician (PCP) should also be notified.
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Q. How are approved requests for authorization confirmed?
A. Approved requests are confirmed in writing, and delivered either by mail or fax. You must receive more than verbal notification for non-emergency care.
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Q. How long does it take to get an authorization approved?
A. We will make a determination within 15 days of receipt of your request. Determinations for urgent requests will be made within 72 hours of receipt. All relevant clinical information must be provided.
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Q. May I submit a request for authorization after a procedure has been performed?
A. Not typically, but requests will be handled on a case-by-case basis. Complete a Request for Authorization form and submit it for consideration.
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