A Referral is given by the member’s PCP when there is a need for the member to see a specialist. Without a referral from the PCP, the treatment may not be covered.
Approval needed for care beyond that provided by your primary care doctor or hospital. For example, managed care plans usually require referrals from your primary care doctor to see specialists or for special procedures.
In healthcare, a process in which a doctor recommends that a patient see a medical professional with advanced knowledge of a certain medical specialty or technique (such as heart disease or dermatology). Also known as a consultation.
the referral of a veteran to a specialist, community nurse or allied health professional (see section 10, 11 and 12).
The process of sending a patient from one practitioner to another for health care services. Health Plans may require that designated primary care providers authorize a referral for coverage of specialty services.
When a recommendation is made and a visitor arrives at a Merchant site as a result of this recommendation.
Establishing a link between a person and another service or support by providing authorized documentation of the person's needs and recommendations for treatment, services, and supports. It includes follow up in a timely manner consistent with best practice guidelines.
Physician recommendation to a patient to see another physician for further evaluation or treatment. In HMOs that use gatekeepers, services provided by specialists or other practitioners usually require a referral by the patient’s PCP in order for the health plan to cover the cost of the care.
To send or direct a person to another service or specialist for further treatment.
Specific directions or instructions from a Member's PCP, in conformance with HMO's policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. | | | | | | | | I-L | | | | P-Q | | | T-Z
A formal request, in a managed care plan, by a primary care physician to specialists, hospitals, or other services, for additional care. Under strict managed care, the referral process may impact payment for additional service.
A referral is consent from your primary care physician to see a specialist for an illness or injury. You may also need a referral to have special treatments, such as x-rays or surgery. A referral saves you money by reducing unnecessary medical costs. Your primary care physician will decide if you need to see a specialist. He or she will help you choose a specialist that is right for you.
A primary care doctor's written permission for a patient to see a certain specialist or to receive certain services. Required by many managed care health plans.
The process whereby a foster child is directed by a primary care provider to another appropriate provider or resource for diagnosis or treatment.
Written approval from a primary care doctor to visit a specialist or receive certain services. Many managed care plans require referrals for services not provided by the primary care doctor such as treatment received from an HIV specialist.
a formal process that authorizes an HMO member to receive care from a specialist or hospital. Generally, an HMO member must get a referral from his or her primary care doctor (PCP) before seeing a specialist to ensure coverage.
An arrangement, usually made by your primary care provider, under which you can be evaluated and treated by another provider, typically a specialist.
A written OK from your primary care physician for you to see a specialist or to receive certain services.
Permission to consult another doctor.
A formal process that authorizes an HMO member to get care from a specialist or hospital. To assure coverage, an HMO patient generally must get a referral from his or her primary care doctor before seeing a specialist.
a recommendation to consult the (professional) person referred to; "this patient is a referral from Dr. Bones"
a powerful thing coming from someone that has personally experienced a product or service firsthand and is willing to stake their reputation on a recommendation to others in their circle of influence
a precious commodity so treat it with care
a process of sending a patient to another provider for services or consultation that the referring source believes is outside their scope of practice and is not prepared or qualified to provide
a recommendation of a product or service from one person to another
a request by the patient's Primary Care Manager (PCM) granting permission for the patient to seek specialty care outside of the PCM office
a request for comments and recommendations sent by the Lands Branch to other Government Departments or Agencies who may have an interest or concern related to the land being applied for
a request from a health care provider that the patient receive additional evaluation and care from a specialist
a request from your Primary Care Physician (PCP) for you to receive care from a specialist or other treatment such as hospital admissions, lab or x-ray services or outpatient procedures
a request to a specialist or a consultant physician for investigation, opinion, treatment and/or management of a condition or problem of a patient or for the performance of a specific examination(s) or test(s)
a written authorization from a primary care physician
The method whereby a physician directs a patient to the services of another physician.
A process by which the primary care physician makes a request to a managed care plan on behalf of the enrollee to receive medical care from a nonparticipating provider or specialist.
A referral is completed by a Primary Care Physician (PCP) when the PCP believes that it is medically necessary for a member to see another provider or specialist. Health plan members who receive a referral should: Confirm with the PCP that the referral is to a specialist in the health planâ€(tm)s network. Ask how many visits and the length of time the referral covers. Check to see exactly what the referral covers (Is it for Consultation only, or consultation and treatment?) Optima Health members can view their referrals online on My Optima.
In relation to medical insurance, referral means authorization from the patient's PCP to seek treatment from a specialist.
A recommendation, usually written, from a physician that a patient receive services from a different provider or facility.
A recommendation from a provider that a patient should receive care from another specific physician or facility. Health plans may require that designated Primary Care Providers authorize a referral for coverage of specialty services.
A formal process that authorizes a plan member to obtain care from a specialist or hospital. Generally, a plan member must obtain the referral from his or her primary care doctor (also known as a "gatekeeper").
A form provided by a member's doctor authorizing services from other Network providers if the attention of a specialist is required.
A recommendation for assessment to determine if a specialized service is required and at what level.
In HMO plans - the insured individual must get an approval (referral) from their Primary Care Physician (PCP) in order to be seen by a specialist within the HMO.
Authorization from your primary care physician or health insurer to see a specialist or receive a special test or procedure. HMOs often require that you obtain a referral for most specialty care. It is important to know what your health insurer's rules and procedures are for referrals.
The process of one health care provider sending a patient to some other health care provider for further treatment or evaluation. With HMOs it often a requirement that a member receive a referral from the gatekeeper in order to use a provider other than the primary care physician for treatment under the plan.
Contact made by hospital personnel to notify the Indiana Donation Hotline of a deceased patient who is a potential organ and/or tissue donor.
A participating provider's direction of an enrollee to seek and obtain covered services from a health professional, a hospital, or any other provider of covered services.
The process through which your primary care physician helps you to get health care from other providers. A referral must be authorized by L.A. Care.
In managed care, a health plan member must first contact his/her PCP to obtain medical services unless it's an emergency. Together, the member and PCP decide if the member needs to see a specialist or obtain special services. This is also be referred to as "preauthorization".
A referral is a formal process in which we authorize a member to obtain care from a specialist or hospital based provider requested by the member's primary care provider (PCP). Without a referral, the member may be required to pay for the specialist's services.
Document from the patients PCP that indicates their authorization of the services indicating that the health plan will pay for the services described and that the specialist will provide those services.
The request for additional care, usually of a specialty nature as requested by a primary care physician or another specialist needing additional medical information on behalf of the patient.
A formal process that authorizes an HMO member to get care from a specialist or hospital. Most HMOs require patients to get a referral from their primary care doctor before seeing a specialist.
The process of a health care provider or gatekeeper sending a patient to another provider for health care services; some health plans require primary care providers to authorize referral for specialty services.
the recommendation of a medical or paramedical professional; can refer both to the act of sending a patient to another doctor or therapist, and to the actual paper authorizing the visit.
When someone, particularly a satisfied client, suggests or recommends services to other buyers.
The recommendation of a medical or paramedical professional. If you get a referral to ophthalmology, for example, you are being sent to the eye doctor. In HMOs and other managed care schemes, a referral is usually necessary to see any practitioner or specialist other than your primary care physician (PCP), if you want the service to be covered. The referral is obtained from your PCP, who may require a telephone or office consultation first. See the entire definition of Referral
means an order by a Member's PCP requesting and recommending that the Member receive services from another physician in accordance with the terms of this SPD.
In the child care field, the process of helping a family or child care provider access a service. For example, locating quality child care for a parent, offering provider information and training, or offering financial assistance information.
Your PCP’s or his/her Contracted Medical Group or IPA’s written permission for you to see a certain Specialist or to receive Covered Services.
One agent's recommendation of a potential buyer or seller to another cooperating agent.
within many managed care plans, transfer to specialty physician or specialty care by a primary care physician.
Primary care physician-directed transfer of a patient to a specialty physician or specialty care.
A recommendation by a physician that an enrollee receive care from a specialty physician or facility.
a request for a service that you cannot get from your PCP or "medical home" cannot provide.
Permission from the PCP that allows a person in an HIV SNP to see a specialist.
If a Primary Care Provider determines that a member has a condition which requires the attention of a specialist, the provider makes a referral to a specialist. Under some plans, a referral by the Primary Care Provider is required to obtain services from other providers.
Authorization that an HMO and other managed care plans usually require for services not provided your primary care doctor. For instance, HMOs generally require you to get a referral from your primary care doctor in order to see a specialist or get an eye exam.
A communication, either verbal, written or electronic, executed by a participating PCP, Medical Director or Participating Specialist providing services, which specifies health services to be rendered by the Physician or Provider identified therein.
Your primary care doctor's written approval for you to see a certain specialist or to receive certain services. Most FEHB HMOs and some Medicare health plans may require referrals. Important: If you either see a different doctor from the one on the referral, or if you see a doctor without a referral and the service isn't for an emergency or urgently needed care, you may have to pay the entire bill.
An OK from your Primary Care Doctor for you to see a specialist or get certain services. In many managed care plans, you need to get a referral before you get care from anyone except your primary care doctor. If you do not get a referral first, the plan may not pay for your care.
A recommendation made to a client about the services of a particular agent or firm.
a process whereby the primary care physician arranges for and authorizes or directs the enrollee to receive services from a specialist physician, hospital, or other provider.
The recommendation by a primary care physician for a member to receive specialized care from a practitioner or facility.
Recommendation for a patient to see, usually, a specialist for further treatment.
May be either an informal suggestion from one provider for the patient to see another provider, or a formal process within managed care plans by which the primary care physician refers the patient to specialists, hospitals or other services.
An authorization given by a provider, usually a primary care provider, allowing a managed care plan member to seek care from a specialist.
A recommendation, a suggestion to a client of the value of the services of a person or firm. (i.e. a real estate agent may refer a purchaser to a particular banker or lawyer.)
The process of sending a patient from one doctor to another or to other health care professionals for services. Most managed care plans require the primary care physician to authorize a referral before the cost of the service will be covered.
If a Primary Care Physician (PCP) determines that an HMO member has a condition which requires the attention of a specialist, the PCP makes a referral to a specialist. For most HMO members (including those with POs coverage using their in-plan benefits) a referral by the PCP is required to obtain most services from specialists or other health care practitioners.
A written OK from your primary care doctor for you to see a specialist or get certain services. In many HMOs, you need to get a referral before you can get care from anyone except your primary care doctor. If you don't get a referral first, the plan may not pay for your care.
The written recommendation by your Primary Care Physician for a member to receive care from a different doctor, provider, or facility.
The recommendation by one agent of a potential buyer and/or seller to another agent either locally or long-distance.
Authorization for a member of a managed care plan to receive care from a specialist or hospital. The member's primary care physician is responsible for making the referral.
The recommendation by a physician and/or health plan for a member to receive care from a different physician or facility.
A formal process that authorizes a member to get care from a specialist or hospital. To assure coverage under some Priority Health plans, a patient must get a referral from his or her primary care doctor before seeing a specialist. Some specialists require a referral from a patient's primary care doctor before they will see a patient.
Written authorization from your health care provider to see another health are provider. For example, your primary care provider may provide written authorization for you to see a specialist.
when your Primary Care Physician directs you to another doctor, specialist, or hospital for care.
The process in most HMOs where the patient's primary care physician authorizes special tests, treatment from a specialist, or other non-routine services.
A written recommendation by a physician for a Member to receive care from a specialty physician or facility.
A referral to the CSE due to suspicion of an educational disability, which is interfering with a child's ability to learn. Teachers, parents, physicians, and guidance counselors may make referral.
A written OK from your primary care doctor for you to see a specialist or get certain services. In many insurance plans, you must have a referral for that plan to pay for the services of the specialist.
The process of one doctor sending a patient to some other doctor for further treatment or evaluation. HMOs often require that a member receive a referral from the gatekeeper in order to be able to use a provider other than the primary care physician for treatment under the plan.
When a dental patient from one office is sent to another dentist, usually a specialist for treatment or consultation.
The authorization necessary to send a member to a specialist, facility or providers outside of plan network for medical services, generally outpatient, in order for the patient to receive complete program benefits.
A written authorization to visit a specialist from an individual’s primary care doctor. In many Medicare Managed Care Plans (Medicare HMO), an individual must get a referral before receiving care from anyone except the primary care doctor. If an individual fails to get a referral, the plan may refuse to pay for care.
A written approval from your primary care physician allowing you to see a specialist or receive additional care. Referrals are a primary requirement of many HMOs in order to ensure coverage and reimbursement.
In some plans, such as most HMOs, your primary care ( i.e. regular) doctor needs to write a referral (permission) for you to go to see a specialist. If you don't have a referral, you may not be able to see the specialist or you'll have to pay the bill yourself.
If your primary care physician determines that you have a condition that requires the attention of a specialist, a written referral will be provided for you to see a specialist.
Occurs when a physician or other health plan provider receives permission to consult another physician or hospital.
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Some insurance companies require that on specific plans a referral must be obtained for certain procedures or visits to specialists. The referral is acquired by the primary care physician (PCP) by contacting the insurance company by phone or mail. This is a request for the service. The referral consists of an authorization code, a number of visits allowed (if applicable) and an expiration date.
Permission from your doctor to consult with another physician or hospital.
Approval or consent by a primary care physician for patient referral to ancillary services and specialists.
The recommendation of a person or business to another.