![]() ![]() As appropriate, we will substitute the "referred to" provider with a provider who is aligned to the capitation arrangement of the requesting provider. *Our referral system recognizes when a specialty capitation arrangement may apply. Learn more about our referral policy in the Office Manual for Health Care Professionals Submit patient referrals through one of our vendors Submit patient referrals through our provider portal Submit an electronic referral in one of two ways: In some instances, we will grant a "modified" response where C&T code 99499 replaces the rejected procedure code. We will return such requests and ask you to resubmit the code(s) using the precertification process. We do not accept procedure codes for services that require precertification. Authorized procedures are subject to the number of visits on the referral. Referrals submitted without a procedure code will default to a C&T referral (99499). We will pay specialists for performing associated covered services in an office setting, according to current claims processing guidelines. In most areas, consult and treat (C&T) referrals do not need to include the specialists’ procedures. C&T referrals – These are referrals submitted with CPT code 99499.We will only reimburse for the procedure code(s) that matches the code(s) on the referral. ![]() Primary care physicians (PCPs) should use these referrals when a member needs care for a specific health reason. Exact procedure code referrals – These are referrals submitted with code(s) other than 99499.Our guidelines for patient referrals allow us to authorize: Timely referrals can also help avoid claims reviews later. Text files are preferred for storage of information due to their simplicity.Keep costs down by referring your patients to specialists who are covered by their plan. The end of a text file denoted by placing an end-of-file marker. A text file is written in binary language and occurs within a computer file system. txt file is based on usage of a basic character set made up of letters, numbers and symbols, a good example being the ASCII character set. Txt format is therefore very popular as it is compatible with many operating systems and software platforms.Ī. It is widespread in use and can be handled by any application program that deals with. ![]() The file type is amongst the oldest file types in existence having been used by the first computers developed. ![]()
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May 2023
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