A. Primary care physicians (PCP) and other participating specialists may direct members to any participating specialist. A formal referral is not necessary.
A. Yes. In order to meet the needs of our members, our plans allow for this kind of flexibility.
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.
A. Providers who have registered for Online Provider Services* may view the status of authorization requests online. Otherwise, approved requests are confirmed in writing and delivered either by mail or fax. You must receive more than verbal notification for non-emergency care.
* For more information about Online Provider Services, please click here.
A. We ask that you submit your prior authorization well in advance of the
service date(s), allowing two weeks (15 days) for a determination to be made.
A. You may, but be aware that expedited requests are defined as those which may seriously jeopardize life or health, or the ability to regain maximum functioning.
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.