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Paper Referrals Will No Longer Be Accepted After April 1, 2007
An Important Message for PCPs and Specialists
Effective April 1, 2007, we will no longer accept paper referrals with HMO/POS claims for payment. All paper referrals submitted on or after April 1 will be returned to the issuing provider.
For PCPs, all referrals should be submitted through NaviNet® or our Interactive Voice Response (IVR) system.
NaviNet or the IVR should be checked to ensure a referral was received for a member before services are rendered. Specialists should no longer accept paper referrals. A fax of an electronically submitted referral may be obtained by the specialist office via our IVR.
Accuracy and Timeliness
This change will help reduce errors by allowing specialists to verify—through NaviNet or the IVR—that a referral is on file in the system and has been submitted correctly, before the provider sees the member. Electronic submission will also help ensure the accuracy and timeliness of claim payments by allowing the specialist to confirm that the group provider number on the referral matches the group provider number on the claim.
Connect to the NaviNet Portal
Please call the eBusiness Provider Hotline at 215-640-7410.
To submit or inquire on an electronic referral through the IVR, please call 866-681-7370. For instructions on using the IVR, refer to the October 2006 issue of Partners in Health Update.
If you have additional questions, please contact your Network Coordinator.