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Referral/Authorization Quick Reference Guide for ...

Referral/Authorization Quick Reference Guide for Commercial Products This is a resource tool for standard HMO, POS, and PPO products; please keep in mind that products may vary by employer group and state. For the Connecticut Open Access HMO product, no referral is required to see a contracted specialist. No guarantee of payment is implied. Use this Guide as a Quick Reference tool, only, as it is not comprehensive. Consult the commercial Provider Manual for specific product and service requirements or call the Provider Service Center at 800-708-4414. KEY. R = referral MRC = Prior Auth Medical Review Criteria PAF = Prior authorization Request Form N = Notification NP = Notification Policy MAPAF = Massachusetts Standard Form for A = authorization AP = authorization Policy Medication Prior authorization SERVICE HMO and In- PPO and Out of Resources Network POS Network POS. Allergy Injections (specialist services) R none MAPAF.

o Extended visits (> 45-50 minutes/session) A A MRC AP: Contact Harvard Pilgrim Behavioral Health Access Center at 888-777-4742. SERVICE HMO and In- ... Neonatal Intensive Care — Notification is required for all non-routine newborn care (level ll - lV) admissions on or after date of service 04/15/17.

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www.harvardpilgrim.org

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fgiguidelines.org

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