Referral to a Preferred Specialist is Done with Ease
No referrals or authorizations are needed for PCP-to-Preferred Specialist referrals, nor for Preferred Specialist-to-Preferred Specialist referrals. Your patients can see any Preferred Specialist/COE specialist for as many visits are required to keep your patients stable and in good health.
Use our Referral Process Tool to determine if a referral is required for the specialist you have chosen with your patient.
- You will need to know if the provider is an HCP Preferred Specialist and your patient’s medical coverage.
- Start by determining the Providers status below.
I am a PCP
I am a specialist in the HCP Preferred Specialist
I am NOT an HCP Preferred Specialist
The patient is covered by Emblem or Anthem Medicare.
- Refer to an HCP Preferred Specialist — No Referral Required
- Refer to a NON-Preferred Specialist — Prior Authorization Required
The patient is covered by Anthem Health Plus (Medicaid), Anthem BCBS Commercial, or Fidelis Care (Medicaid).
- Referral activity not managed by HCP
Providing Care to a HealthCare Partners, IPA patient / Referring to another HCP Preferred Specialist
- The patient is covered by Emblem or Anthem Medicare — No Referral Required
- The patient is covered by Anthem Health Plus (Medicaid), Anthem BCBS Commercial, or Fidelis Care (Medicaid) — Referral activity not managed by HCP
Referring to a NON-Preferred Specialist
- Prior Authorization Required
Providing Care to a HealthCare Partners, IPA patient
- Prior Authorization Required
Referring to another Specialist
- The patient is covered by Emblem or Anthem Medicare
- Referring to an HCP Preferred Specialist — No Referral Required
- Referring to a NON-Preferred Specialist — Prior Authorization Required
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- Refer to an HCP Preferred Specialist — Notification Required
- Refer to a NON-Preferred Specialist — Prior Authorization Required
- The patient is covered by Anthem Health Plus (Medicaid), Anthem BCBS Commercial, or Fidelis Care (Medicaid)
- Referral activity not managed by HCP