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Entering & Verifying Referrals

Enter referrals electronically
You can enter and check referrals for all members in managed care plans, including those out-of-area, through one of the following eTools:

  • Online Services()
  • Emdeon Office
  • A direct ANSI 278 connection through Change Healthcare

Referrals can be entered for up to 99 visits, and are good for 365 days.

Note: A referral does not guarantee reimbursement. Member benefits and medical and payment policies may affect coverage and reimbursement.

Verify referrals before rendering services
Verifying that a referral is on file and that the number of requested visits matches the services required helps facilitate the claims process and avoids unnecessary appeals or inquiries.

To inquire on a referral using Online Services(), go to Service Review>Check Status:

If there is a referral for the member, Online Services will display a confirmation that includes:

  • The specialist’s name
  • A referral number
  • The number of visits certified, and
  • The completion date for those visits

Here is a sample of a referral confirmation from Online Services: