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Entering & Verifying Referrals

You can manage referrals electronically using Online Services, Authorization Manager, or a direct connection. Learn more about our technologies.

Entering referrals

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

  • A direct ANSI 278 connection through Change Healthcare
  • Online Services (to be replaced with ConnectCenterTM in 2022)
  • Authorization Manager:

    Important: Procedure code 99243 is required, as well as a diagnosis. If no diagnosis is available, you may enter general symptoms (R68.89). Then continue as you would with an authorization request.

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 search for an existing referral in Authorization Manager go to the Medical Authorizations screen. Detailed instructions are in the Authorization Manager User Guide.

To inquire on a referral using Online Services (to be replaced with ConnectCenterTM in 2022), 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:

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