What type of referral management to specialty care is anticipated?
PCPs can refer patients to any specialist participating in Medicaid. As the patient’s medical home, PCPs are responsible for coordinating the referral. TMHP provides PCPs a referral form to help coordinate and arrange specialty care, but PCPs are not required to use the form. To arrange a referral, the PCP must give the specialist his or her Medicaid provider number at the time of the referral. PCPs may authorize one visit, a specified number of visits, or a specified period of time. When submitting a claim for specialty care, specialists must include the PCP’s Medicaid ID number on the claim. Refer to the PCCM provider manual for additional information.
PCPs can refer patients to any specialist participating in Medicaid. As the patient’s medical home, PCPs are responsible for coordinating the referral. TMHP provides PCPs a referral form to help coordinate and arrange specialty care, but PCPs are not required to use the form. To arrange a referral, the PCP must give the specialist his or her Medicaid provider number at the time of the referral. PCPs may authorize one visit, a specified number of visits, or a specified period of time. When submitting a claim for specialty care, specialists must include the PCP’s Medicaid ID number on the claim. Refer to the PCCM provider manual for additional information.
