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