What if a member self refers without contacting the PCP first?
If a member informs the specialist office that they elected not to contact the PCP and want to be treated without the PCP’s authorization, the specialist should indicate SELF in field 23 of the HCFA claim form or field 63 of the UB92 claim form. CDPHP also suggests that the specialist office ask the member to sign the CDPHP specialist waiver form. Please remember that some members are allowed to self-refer for certain services, and an authorization form is not always needed.
