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  Authroizations/Referrals

 
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Does the doctor to whom we refer a patient have to be participating with the MCO or MHN?



For MCO members, yes. Each MCO has a network of specialists, hospitals, pharmacies and other providers which must be used. Contact the applicable MCO for a listing of their network in your area.

For MHN members, no. The MHN program does not have a network of specialists; so you may continue to refer your patients as you have done in the past. However, the specialists must accept Medicaid patients and file the claim(s) referencing the 6-digit referral number as required.


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