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Referral procedures for hospital admissions

February 13, 2017

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As outlined in the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers and the Provider Manual for Participating Professional Providers, when referring an Independence member for a surgical procedure or hospital admission, the primary care physician needs to issue only one referral to the specialist or attending/admitting physician.

Please note the following:

  • The referral will cover all facility-based (i.e., hospital, ambulatory surgical center) services provided by the specialist or attending/admitting physician for the treatment of the member?s condition.
  • The referral is valid for 90 days from the date it was issued.
  • The admitting physician should obtain the required preapproval.
  • Any pre-admission testing and hospital-based physician services (e.g., anesthesia) will be covered under the hospital or surgical preapproval.

Certain products (e.g., HMO, POS, PPO) have specialized referral and preapproval requirements and/or benefits exemptions. Please be sure to check our website for a list of services requiring preapproval.

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