In-Network Self-Referrals Clause Samples
The In-Network Self Referrals clause governs situations where a healthcare provider refers a patient to another provider or service within the same insurance network. Typically, this clause outlines the conditions under which such referrals are permitted, such as requiring that the referred provider is part of the same network or that certain documentation is completed. By establishing clear guidelines for self-referrals within a network, the clause helps prevent conflicts of interest and ensures that patient care remains coordinated and cost-effective.
In-Network Self-Referrals. The Contractor agrees to have written policies and procedures that permit members at a minimum to self-refer for one annual and up to five (5) GYN/Family Planning visits annually and for sexually-transmitted (STD) services, without obtaining a referral from the Primary Care Provider. These policies and procedures must also include that members may see out of network providers for these services.
In-Network Self-Referrals. The Contractor agrees to have written policies and procedures that permit members to self-refer for in-network behavioral health services, rather than obtaining a referral from their Primary Care Provider. These policies and procedures must identify timely access standards for behavioral health services. The Contractor will notify members of the right to access behavioral health services without a referral from their PCP. The Contractor will establish provisions for the coordination of this care with the PCP that takes into account patient confidentiality requirements.
In-Network Self-Referrals. The Contractor agrees to have written policies and procedures that permit members to self-refer for in-network substance use disorder services, rather than obtaining a referral from their Primary Care Provider. These policies and procedures must identify timely access standards for substance use disorder services. The Contractor will notify members of the right to access substance use disorder services without a referral from their PCP. The Contractor will establish provisions for coordination of this care with the PCP that takes into account patient confidentiality requirements.
In-Network Self-Referrals. Contractor agrees to have written policies and procedures that permit members to self-refer for in-network mental health services, rather than obtaining a referral from their Primary Care Provider. Contractor shall establish provisions for the coordination of this care with the PCP that takes into account patient confidentiality requirements.