Patient Referrals

Does your patient need a referral?

If your patient needs to see a participating specialist, you must provide him or her with a referral. The referral should be written on a prescription or referral form. As a reminder, the following do not require a referral:

  • Routine gynecological care
  • Family planning services
  • Mammograms
  • Routine obstetrical care
  • Routine eye examinations by an optometrist or eye doctor
  • Dental care
  • Behavioral health care for DDD, MLTSS and FIDE-SNP members
  • Services at a Federally Qualified Health Center
  • Emergency room visits
  • Medicare-covered services for members enrolled in Medicare