Q: After January 1, 2007, will I continue to need a referral to see a Specialist?

A: Yes, members should be referred by their Primary Care Provider (PCP) for a referral. To provide continuity and coordination of care, your PCP will document the referral to the Specialist in the member’s medical record with the diagnosis for the referral.  The PCP office will schedule the appointment with the Specialist to communicate the diagnosis and need for the member’s referral.  All test preformed by the PCP may be forwarded to the Specialist along with any information the PCP would like the Specialist to review. 

In continuing the coordination of care, the Specialist is encouraged to report the visit findings back to the member’s PCP.  Members are encouraged to return to follow-up with their PCP after a visit or episode of care from a Specialist.

Q: Will I receive an approval letter for my visit to the Specialist?

A: Members will no longer receive an approval letter from Community Health Plan for a referral to a Specialist.  The referral will be noted in the member’s PCP medical record.

Q: How will I obtain services from an out-of-network provider if the services are not available in-network?

A: Your PCP will need to obtain a prior authorization for services to an out-of-network provider.