It is the policy of the Practice to abide by all applicable rules and regulations regarding referrals, preauthorizations, and pre-certifications for the insurance companies with which it participates. This includes but is not limited to requiring a face-to-face evaluation or requesting medical records for patients without a visit in the last 30 days or if there has not been a visit to address the issue originating the referral.
Before sending the referral, all attempts will be made to satisfy the patient’s insurance requirements.
The practice lists preferred clinicians per specialty, but patients can request a clinician of their choice.
Once the condition and appropriate ICD-10 code are selected, and information gathered, a referral order will be entered in the system for the Patient Care Coordinator to fax within 48 hours of order creation.
Patients will be provided a copy of the referral order for their records and follow-up.
Patients whose insurances require prior authorization or request clinicians out of their network should expect a lengthening of this process to allow for insurance approval.