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What if we receive a request for a referral for a patient we have never seen before?



For MCO, PCPs may not refer patients they have never seen for specialty care. The monthly enrollment report identifies new enrollees to the pratice. PCPs are strongly encouraged to contact new enrollees and schedule a visit to establish a medical record.

For MHNs, PCPs may; but are not required to authorize specialty care for patients they have not seen. Your monthly enrollment report identifies new enrollees to the pratice. PCPs are strongly encouraged to contact new enrollees and schedule a visit to establish a medical record.


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