Out of Network Requests. The process BlueLincs HMO Participating Providers follow to obtain authorization from BlueLincs HMO when a BlueLincs HMO Member needs specific Medically Necessary services which are unavailable within his/her network.
Out of Network Requests. Group Participating Providers are required to refer BlueLincs HMO Members to BlueLincs HMO Participating Providers unless, in Group Participating Provider's best medical judgment, there is no BlueLincs HMO Participating Provider who can provide the Medically Necessary services needed for a BlueLincs HMO Member. The Group Participating Provider may submit an Out of Network Request when a BlueLincs HMO Member needs Medically Necessary services which are unavailable within his/her network by contacting BlueLincs HMO's Prior Authorization Department as set forth in Article VI of the Agreement. Non-Network Providers must be approved by BlueLincs HMO prior to ordering services on behalf of the BlueLincs HMO Member. The Group Participating Provider shall also provide complete information on authorized care or services to the out of network provider to whom the BlueLincs HMO Member is being referred.
