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Mark Sanford, Governor
Emma Forkner, Director
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FAQs
>> Authroizations/Referrals
Authorizations/Referrals
FAQ Table of Contents
Enrollment/Disenrollment
Authorizations/Referrals
Primary Care Physicians
ID Cards
Pharmacy
Miscellaneous
Do all Medicaid covered services require authorization from the health plan?
What if MCO or MHN enrollees assigned to my practice need health care my office cannot provide?
Does the doctor to whom we refer a patient have to be participating with the MCO or MHN?
What if we receive a request for a referral for a patient we have never seen before?
What if the PCP wont give authorization becasue they have not seen the beneficiary or do not know them?
Is PCP authorization required each time a Specialist sees an MCO or MHN enrollee?
Can referrals be made by telephone?
Do MCO and MHN enrollees admitted through the ER require PCP authorization?
Can a PCP authorize initial and follow-up care at the same time?
What happens if their physician refers a beneficiary to a specialist that does not accept their managed care plan?
How should claims be filed when a PCP refers an enrollee to our office?