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Wednesday, April 23, 2014
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Summary of Benefits and Coverage

Summary of Benefits and Coverage

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We're glad you're a part of the Exclusive Care Team

We're glad you're a part of the Exclusive Care Team

 
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Baby and Female DoctorOur contracted network providers play a vital role in delivering quality care to our members.

We greatly value our partnerships and appreciate the wonderful family-oriented environment and relationships you pass on to our members.

  

 

 

Nurse and patient reading pamphletAs our partner, assisting you is one of our highest priorities.

We welcome your feedback and we look forward to supporting all your efforts to provide quality care to our members.

 

 

Need a referral form?

 
For a Referral Request Form, click here 
 
For a Direct Referral Request Form, click here
 
For the Exclusive Care Provider Manual, click here
 
What if I need to see a specialist? 

Prior authorization is not required for many services, and your PCP may make a direct referral to a contracted provider. Annual well woman exams, OB services, mammograms, bone mineral density testing, initial chiropractic evaluation, mental health services, family planning, and several other services may be referred directly by your PCP without prior authorization. The direct referral form and a list of services covered under the direct referral policy may be viewed here.

Your Primary Care Physician will complete a referral form, attach appropriate medical documentation and fax information to the Medical Management Department. Medical Management will review and respond to your PCP within 48 hours.

Approved referrals are faxed back to the PCP and a hard copy is sent to your address so an appointment can be scheduled. If an incomplete referral is received, Medical Management works with the PCP’s office to obtain all of the needed information. Members and PCPs are notified via letter of denied referrals.

 

  

 

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