SPECIALIST REFERRALS. If your Participating Dentist decides that you need the services of a specialist, they will request Prior Authorization for a referral to a CDN Specialist. CDN will send you a letter of treatment authorization, including the name, address, and phone number of your assigned CDN specialist. Routine Prior Authorization requests will be processed within five (5) business days from receipt of all information reasonably necessary and requested by CDN to make the determination. If an emergency referral is required, your Primary Dentist will contact CDN and prompt arrangements will be made for specialty treatment. Emergency referrals are processed within seventy-two (72) hours from receipt of all information reasonably necessary and requested by CDN to make the determination. Your Primary Dentist will be informed of CDN’s decision within 24 hours of the determination. Both the general provider and the patient will be notified in writing of approval or denial. If you have questions about how a certain service is approved, call CDN toll-free at 0-000-000-0000. If you are deaf or hard of hearing, dial 711 for the California Relay Service. We will be happy to send you a general explanation of how that type of decision is made or send you a general explanation of the overall approval process if you request it. If you request services from any specialist without prior written approval, you will be responsible for payment.
SPECIALIST REFERRALS. Provider agrees to refer INSUREDS to a USA contracted participating specialist when necessary, and when consistent with good medical practice. Provider further agrees to use the services of other USA contracted ancillary service providers when necessary and when consistent with good medical practice. A toll-free number will be provided on INSURED'S I.D. card to obtain the names and locations of such specialists participating with USA.
SPECIALIST REFERRALS. You have two options if you need to see a Specialist. This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. With this option, you do not need a referral from your PCP to visit an Access+ Specialist in your Medical Group. You can self-refer to an Access+ Specialist for: • An examination or other consultation; and • In-office diagnostic procedures or treatment. You cannot self-refer to an Access+ Specialist for: • Allergy testing; • Endoscopic procedures; • Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement; • Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics; • Infertility services; • Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or • Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.
SPECIALIST REFERRALS. If Provider determines after examination of a Member that the treatment required for the Member will require specialist services of a Participating Facility which are outside the area of specialization of Provider, Provider shall consult with the PCP regarding the needed treatment and the needed services of an additional Participating Facility, and if the PCP considers such referral necessary, the PCP shall make an additional referral of the Member to the appropriate Participating Facility as determined to be necessary as a result of the discussions with Provider, in accordance with the referral policies of SelectCare.
SPECIALIST REFERRALS. Within four (4) weeks or shorter as medically indicated. A specialty referral visit is an encounter with a medical specialist that is required by the enrollee's medical condition as determined by the enrollee's Primary Care Provider (PCP). Emergency appointments must be provided within 24 hours of referral.
SPECIALIST REFERRALS. The CONTRACTOR shall maintain a procedure to identify and evaluate member specialty provider utilization by PCP panel.
SPECIALIST REFERRALS. Not all general dentists are capable of performing each of the services listed herein and, based upon the Member’s condition, certain procedures may not be within the scope of practice or ability of a general dentist. In such cases, the general dentist will refer the member to a dental specialist. The costs of services provided by a dental specialist are NOT a covered benefit under this plan, however, should a Member’s CDN Provider determine that the services of a specialist are required for the Member’s treatment, CDN will forward the Member and/or the non- covered parent of a covered child, a letter of treatment authorization, including the name and address of the nearest CDN specialist. If an emergency referral is determined, the Member’s Provider will contact CDN and prompt arrangements will be made for specialty treatment. All requests for specialty care must be previously approved. Both the general provider and the patient will be notified in writing of approval or denial. A copy of the plan’s written policies for Utilization Review and Specialty Referral are available upon request. If you request services from any specialist without prior written approval from CDN, you will be responsible for the specialist’s fee for any services rendered.
SPECIALIST REFERRALS. Member Providers agree to refer INSUREDS to a USA contracted participating specialist when necessary, and when consistent with good medical practice. Member Providers further agree to use the services of other USA contracted ancillary service providers when
SPECIALIST REFERRALS. SCP will not refer Member for additional services without the prior consent of the Member’s PCP and SWH. SCP will not refer Member to any provider who is not a Participating Provider for services unless prior approval is obtained from SWH. SCP shall promptly notify Member’s PCP of the outcome of all services provided to Member to allow PCP to evaluate the outcome of the referred services and coordinate Member’s further medical needs. The following terms shall apply to all Group Participating Providers.
SPECIALIST REFERRALS. Mernber Providers agree to refer INSUREDS to a USA contracted paiticipating specialist when necessary, and when consistent with good medical practice. Member Providers further agree to use the services of other USA contracted ancilla1y service providers when necessary and when consistent with good medical practice. A toll-free number will be provided on INSURED'S I.D. card to obtain the names and locations of such specialists participating with USA. 02/03/2021
