Is prior authorization or referrals required for the Aetna Medicare OpenSM Plan?
PFFS plans cannot require members to obtain prior authorization or referrals prior to receiving covered services. We do encourage prior notification for certain services, including inpatient care, skilled nursing, home health and some DME. To provide prior notification on behalf of a PFFS member, the provider should contact our Aetna Patient Management Department. Aetna Medicare OpenSM Plan members are not required to select a PCP, and there are no referrals required.
