Referrals and Authorization

If the physician feels that the patient needs to see a specialized medical professional, a referral needs to be issued, which is basically an approval to see the specialist.

If the physician feels that the patient needs a service that requires prior authorization, such as injection, durable medical equipment, a transplant, etc,  the patient is issued approval for coverage from the plan before this service is provided. This is pre-authorization.

Ascertain coverage and related benefits

Share all patient details for approval

Pass on the authorization document

We have our eye on the timelines!

Our FTEs are well aware of the services for which approval is required in advance and make sure that the specialist being referred to is a part of the network. They also take care that the appointment scheduling is done within the time frame covered by the referral and inform how many visits the referral covers.


The referral is a formal process that authorizes a patient to get care from a specialist or hospital.

The referral helps to make sure the patient receives proper care when they see the specialist. Pre-authorization is important in order to acquire reimbursement for many non-emergency medical procedures and services.

Also, verifying and approving authorization requirements before the service avoids denials and contributes to an increase in collections.

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