Change to In-Network Referrals Timeline

Submitted by admin on Tue, 07/10/2012 - 19:30

Date: July 10, 2012

Effective Date: July 1, 2012

RightCare is changing its current policy as it relates to referrals. Effective 7/1/12, the in-network referral is valid for 180 days for a maximum of six visits unless otherwise authorized by the Primary Care Provider.

As a reminder, authorization from RightCare for in-network referrals will no longer be required for most specialty referrals. The initial consult for in-network dermatology, plastic surgery, podiatry, and any Primary Care Provider other than the Primary Care Provider of record -- or a provider listed with RightCare as a covering provider for the Primary Care Provider, do not require an authorization when billed with the PCP referral.

The steps for an in-network referral are listed below:

• Primary Care Provider determines medical necessity for referral for specialty services
• Primary Care Provider sends universal referral form to specialist with all pertinent information, including test results, etc., if available
• Specialist provides follow-up information to the Primary Care Provider post visit

For questions related to this topic, please refer to the provider manual located at www.rightcare.swhp.org or by calling 1-855-TX-RIGHT.