|
Special Notes |
Physician Service |
Referral Form Required |
Case Reference Pre-Certification Phone Reference |
Initiating Provider |
|
Must
Be Capitated |
Primary Care |
No |
No |
|
No Contract for this Service |
Gerontology |
|
|
|
|
Must
Be Capitated |
Pediatrics
|
No |
No |
|
|
Must
Be Capitated |
Care
Clinic |
No |
No |
|
|
|
Specialty |
Care Office |
Visits |
|
|
|
Audiology |
Yes |
Yes |
PCP |
|
|
Cardiology |
Yes |
Yes |
PCP |
|
|
Dermatology |
Yes |
Yes |
PCP |
|
|
Ear
Nose & Throat |
Yes |
Yes |
PCP |
|
|
GYN
|
No |
No |
|
|
|
Neurology |
Yes |
Yes |
PCP |
|
|
Nutritional
Counseling |
Yes |
Yes |
PCP |
|
|
Oncology |
Yes |
Yes |
PCP |
|
|
Ophthalmology |
Yes |
Yes |
PCP |
|
|
Orthopedics
|
Yes |
Yes |
PCP |
|
|
Podiatry |
Yes |
Yes |
PCP |
|
|
Surgery |
Yes |
Yes |
PCP |
|
|
Urology |
Yes |
Yes |
PCP |
Gilda C. Chinnici, CHAM Permission Required © Riv. 2-2000
æ Specialty Care Providers can expand referrals for additional visits and/or tests for same diagnosis by calling Referral Management