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:
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 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(), 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: