Referrals for AdvantageCare Physicians Patients

Date Issued: 5/16/2018

To make the referral process for AdvantageCare Physicians patients as efficient as possible, we want to clarify which aspects of patient care should be handled directly by a specialist and which should be managed by an AdvantageCare Physicians primary care physician.

Consultations
If a specialist believes that an AdvantageCare Physicians patient needs a referral to a sub-specialist, that request must go back to the AdvantageCare Physicians primary care physician. If the primary care physician decides that a referral to a sub-specialist is the correct course of care for the patient, he/she is responsible for making the referral to the sub-specialist.

Tests and Services
Specialists are empowered to refer AdvantageCare Physicians patients for additional in-network testing and services within the guidelines of their specialty. Examples include:

  • Chemotherapy
  • Dialysis
  • Laboratory services
  • Radiation therapy
  • Radiology including advanced diagnostics
  • Rehabilitation services (PT, OT and ST)

In these cases, the specialist should get the necessary pre-authorization(s). Information about obtaining pre-authorizations can be found in the Provider Manual.

In all instances of patient care, especially those involving high-cost treatments, AdvantageCare Physicians values relationships with specialists who keep an ongoing dialogue with the primary care physician to ensure true co-management of the patient’s care.