Primary Care Referrals
All primary care services offered by the assigned Primary Care Provider (PCP) are made available at the discretion of the provider. The PCP makes referrals to in-network providers for specialty care, including chiropractic, hearing and ophthalmologic services.
NOTES:
• Referrals are not required for optometry services or standard/covered eyeglasses. A referral is required for services provided by an ophthalmologist.
• Referrals are not required for outpatient in-network psychiatric office visits or other outpatient behavioral health services.
Referral numbers are available to PCPs from MED3000 via phone, fax or eINFOsource (https://pedicare.einfosource.med3000.com/tzg/eservice). The referral number must be entered into the MED3000 system for the specialty provider to be paid. It should be given to the specialty provider accepting the member on referral, who should include the referral number on the claim form to expedite claims payment.
To make a referral:
• Log into INFOsource or
• Call 1-800-492-9634 or
• Use the Referral_Auth_Request form and fax it (toll-free) to 1-866-256-2015.
All claims for services by specialty providers, as well as providers of chiropractic and hearing services, must have a corresponding referral number in the electronic database that is issued by the PCP. Specialty providers who wish to refer to other specialty providers will need to involve the PCP in the referral process. The number issued to the specialist should be included on claims for any services ordered by that specialist except those requiring authorization.
