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What is the difference between a referral request and an authorization request?

April 26, 2017Authorization referral request

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What is the difference between a referral request and an authorization request?

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A referral request is a request by a primary care physician ( PCP ) for ODS approval for a patient to see a specialist. An authorization request is a request for approval of a service for a member based on review of the member’s plan benefits and/or review of the service for medical necessity.