Can an in-house provider initiate referrals?
Yes. In-house providers are usually a substitute for the PCP when he/she is not available and are usually given the authority from the PCP to authorize referrals. It is up to the PCP to determine the amount of referral authority granted to in-house providers. The PCP’s provider number, and not the number of the covering provider, must be provided on the referral verification. Can someone other than the PCP sign a referral? Yes. The PCP or in-house provider can designate a staff member to complete, sign and date referrals. The key is that the referral must be initiated by the PCP or in-house covering provider. What should be done when a referral is requested after-the-fact? Check with clinic providers and/or the medical record to see if the service was prior authorized or directed by the PCP or in-house covering provider. If the service was prior authorized/directed, then the referral verification can be completed and sent to the referred-to provider after the date of service. Should a
