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Referral & Prospective Review Policies & Guidelines

Several projects were completed in this focus area, aimed at educating providers as to when referrals and prospective reviews are necessary, and relaxing some rules around the referral/prospective review process.

» Frequently Asked Questions about Referrals and Prospective Review

Frequently Asked Questions
(.pdf | 31k | Version 10.08.07)


» Using Standard Referral Actions & CHITA Form

Guideline for Standard Referral Actions
(.pdf | 45k | Version 10.08.07)

CHITA Standard Referral Form
(.pdf | 62k | 04/03)


» Guideline for Women’s Healthcare

Guideline for Women's Healthcare
(.pdf | 33K | Version 10.08.07)


» Numeric Billing Codes on Referrals and Authorizations

Coding Policy
(.pdf | 12K | Rev 6.0 | 4.18.04)


» Tolerance Period for Referral Effective Dates

Tolerance Period Policy
(.pdf | 13K | Rev 6.0 | 4.19.04)


» Reduce Administrative Burden on PCP & Emergency Room

Hospital ER Referral Policy
(.pdf | 11K | Rev 6.0 | 4.19.04)


» Guidelines for Requesting a Prospective Clinical-Medical Review

Requesting Prospective Review Guideline
(.pdf | 23k | Version 10.08.07)

Standard Form
(.pdf | 29k | Version 10.08.07)

 




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