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Overview of New Referral Policy for M.D. IPA and Optimum Choice
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Medical Referral |
Primary Care Physician completes Referral Form
- Valid up to 4 visits in 6 months*
- Must designate services
- If Primary Care Physician does not indicate number of visits, the Referral is valid for one visit only
- See Referral Policy on www.mamsiUnitedHealthcare.com for more detail
For additional visits to the Specialist beyond the number specified on the Referral Form, the Member must obtain a new Referral from his or her Primary Care Physician
For services other than those designated on the Referral Form, the Member must obtain a new Referral from his or her Primary Care Physician
Use paper Referral Form or electronic Referral
- Paper Referral Forms available on www.mamsiUnitedHealthcare.com
- Electronic Referral use Online Referral System (ORS) located at www.mamsiUnitedHealthcare.com
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Behavioral Health Referral |
No change at this time
ORS will no longer be available for Behavioral Health Referrals effective September 1, 2006
Except in certain geographic areas, Psychiatrist completes Consultant Treatment Plan for Primary Care Physician review and approval
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Standing Referral |
No change, Standing Referral valid up to 6 months
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Consultant Treatment Plan |
No longer used for Referrals to Specialists for medical services issued on or after September 1, 2006
Consultant Treatment Plan completed by Specialist and signed by Primary Care Physician prior to September 1, 2006 remain valid
Continue to be used for behavioral health services
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Claims |
For Referrals issued on or after September 1, 2006, Specialist attaches copy of Referral Form to the claim for medical services
If Primary Care Physician uses ORS, Specialist does not need to attach referral to claim and may submit claim electronically
For behavioral health services, Specialist attaches copy of Referral Form or Consultant Treatment Plan.
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