Admin Simp Tools: Referral Guidelines

	Administrative Simplification Tools

Administrative Simplification Tools : Referral Guidelines

Referral Guidelines

Referral Guidelines for Managed Care Products

You can CUSTOMIZE YOUR OWN REPORT of Referral Processing Guidelines. First select the service categories you'd like to see, and then select up to 4 health plans. If you want more than 4 health plans, run this report again.

Step 1: Select your service categories of interest

Alternative Medicine	Ambulance	Ambulance for non-emergent inter-facility Transport
Anesthesia Services (Surgical)	Anesthesia Services for Pain Management	Bone Density Scan
Cardiac Rehab	Chemotherapy Administration	Chemical Dependency
Chiropractic Care	Dental Injury	Educational Services
Emergency Room Visit	ER Follow-up Visit	Eye Exam - Routine
Home Health Care	Home IV	Home Medical Equipment
Hospice	Immunizations	Infusion Therapy (Treatment, other than Chemotherapy, that is typically infused)
Inpatient Hospital Stay	Massage Therapy (by a licensed massage therapist)	Maternity
Medical Supplies	Mental Health	MRI & CT Scan
Neurodevelopmental Care	Occupational Therapy	Oral Surgery - Medical
Orthotics - Casted	Orthotics - Other	Outpatient Diagnostic X-Ray, Lab & Pathology
PET Scan	Physical Therapy	Private Duty Nursing
Prosthetics	Pulmonary Therapy	Radiation Therapy
Rehabilitation Care	Sleep Studies - Facility	Sleep Studies - Home
Specialty Clinic, e.g. Coumadin	Specialty Physician Hospital Call/Consult (Inpatient)	Specialty Physician Hospital Surgery/Procedure (Inpatient or Outpatient)
Specialty Physician Office Call (Outpatient)	Specialty Physician Office Surgery/Procedure (Outpatient)	Speech Therapy
TMJ Treatment	Urgent Care (walk-in clinic)	Well Child Care
Well Newborn Care Inpatient	Well Patient Physical	Wound Care

Step 2: Select health plans (limit four)

	Aetna		First Choice Health Administrators		Group Health		KPS Health Plans
	Molina Healthcare of Washington		Premera Blue Cross		Regence BlueShield		UMP
Information not yet available from the following:
na	Cigna Healthcare	na	Columbia United Providers	na	Community Health Plan of Washington	na	Kaiser Permanente Northwest
na	One Health Plan of Washington	na	PacifiCare, a UnitedHealthcare Company

Important Note:
Before displaying this report, please note that important explanatory information about the contents of the report can be found by clicking on Considerations for Using Processing Tables. This information can be downloaded and then assembled with your customized report.

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Tools Quicklink:
» Using Common Modifiers
» Splitting Claims
» Prospective Review Guidelines
» Inpatient Stay Review
» Health Plan Contacts
» Adoption Matrix

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