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Wednesday, 18 April 2012 14:56

 

Beginning May 1, 2012, CLAIMS PAYMENT CAN BE DENIED FOR FAILURE TO HAVE A REFERRAL IN PLACE PRIOR TO THE VISIT.

 

On January 1, 2012, Bravo Health initiated a referral process for specialist visits utilizing HealthSpring Connect (HSC) physician portal.  Please note: 

 

PRIMARY CARE PROVIDER’S (PCP) REFERRAL RESPONSIBILITIES:

  • The PCP is required to obtain a referral for the member by accessing Bravo Health’s online portal at http://hsconnect.bravohealth.com prior to the specialist visit.
  • All referrals MUST be obtained prior to specialist services being rendered. The patient should not return to the PCP to request a referral after the service has been rendered. 
  • Patients are to be referred to in-network providers. 
  • Each referral is valid for 120 days or up to 180 days starting from issue date.
  • Referrals to non-participating providers always require prior authorization from Bravo Health. 
  • Emergency visits do not require a referral or authorization

 

SPECIALIST REFERRAL RESPONSIBILITIES:

  • Specialists must obtain a referral from the PCP prior to seeing the member.
  • Specialists are required to communicate to the PCP via consultation reports any significant findings, recommendations for treatment and the need for any ongoing care.
  • Specialists may refer the patient directly to another specialist if the referral is related to the original referring diagnosis.  If the diagnosis is not related to the original referring diagnosis, then the referral must be obtained from the PCP.
 
A complete listing of the referral process and resources is included in the 2012 Bravo Health Provider Manual and available on their website at http://hsconnect.bravohealth.com
 
 


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