What is the process of sending an HNE member to a non-HNE provider?
If a member does not have Out-of-Plan benefits, but needs to see an Out-of-Plan specialist, the referring in-plan physician must submit a Prior Authorization Request Form (PARF) to our Health Services Department. This is subject to review and would be considered only if the services are not available in-plan. The review process normally takes 24-48 business hours.
Related Questions
- If a provider administers 8 gm of a drug that has a NDC and 2 gm were wasted during the process, does the provider bill for 10 gm, or only the 8 gm that was used?
- How should the open disclosure process be managed when more than one indemnity provider (ie TMF and an MDO) is involved?
- How does this process work if an agency contracts with another agency or provider of services in the OMRDD system?
