You can manage referrals electronically using Online Services, Authorization Manager, or a direct connection. Learn more about our technologies.
You can enter and check referrals for all members in managed care plans, including those out-of-area, through one of the following eTools:
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.
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 (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:
Here is a sample of a referral confirmation from Online Services: