Referral Exempt Providers
Referrals are not required for services provided by the following participating provider types, unless otherwise specified:
- Advanced Practice Midwife
- Anesthesiology / CRNA / Anesthesiologist Assistant
- Clinical Nurse Specialist
- Emergency Medicine
- Nurse Practitioners
- Obstetrics & Gynecology
- Optometrist / Ophthalmology
- Pathology
- Physicians Assistants
- Psychiatric / Mental Health Practitioner
- Radiology
Referral Exempt Services
The following services are referral-exempt when provided by a participating provider:
- Annual Routine Physicals
- Diagnostic Services (e.g., imaging, labs, pathology)
- Durable Medical Equipment
- Home Health & Hospice
- Home Infusion
- Nuclear Medicine
- Orthotics & Prosthetics
- Outpatient Behavioral Health
- Physical, Occupational, and Speech Therapy
- Prescription Drugs & Part B Drugs
- Routine and Specialty OB/GYN
- Routine Ophthalmology / Optometry
- Services from the PCP or the covering midlevel provider
- Urgent Care & Emergency Room Visits
- Note: Follow-up care after an ER visit may require a referral.
Important: Authorization may still be required for certain services (e.g., inpatient care, adjunctive dental). Please check the benefit repository and submit supporting documentation when needed.