How does the MIT Health Plans Office decide whether or not to approve a referral request?
Referral requests are reviewed by Health Plans Claims and Member Services to determine if the requested service is a covered benefit and if the service is available at MIT Medical. Referrals for regularly covered services (this includes most diagnostic tests) made to Blue Cross Blue Shield (BCBS) PPO providers are routinely approved within two business days. Requests for outside services that are available at MIT Medical or requests for coverage of conditionally covered services require review by both the MIT Health Plan’s clinical reviewer and by Claims and Member Services. The clinical/administrative review will determine if the requested service is a “covered benefit” under your health plan and will evaluate the medical necessity of the service. Initial determinations on these requests are completed within five business days.
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