Why Do I Need Referrals and Prior Authorizations?
As a SharedCare member you are an active participant in your overall health care. A referral is required if your Primary Care Provider (PCP) wants you to see another doctor/specialist about a certain condition you are dealing with. Before you see the other doctor/specialist, you must contact the SharedCare Nurse Care Manager at 541-647-1765 to get the Referral approved. If you fail to do so, SharedCare will not pay for the other doctor/specialist and you will be responsible for the associated charges.Prior Authorization is necessary for certain medical services or tests that are ordered by your doctor and requires that you contact SharedCare’s Nurse Care Manager at 541-647-1765 for approval. Unless it is an emergency situation, if you have one of these services/test performed without prior authorization, SharedCare will not pay for the service/test and you will be responsible for the associated charges. If it is an emergency situation you are responsible for contacting SharedCare as soon as possible afterwards.
Some basic information is necessary when you contact SharedCare for a Referral or Prior Authorization. Please work with your PCP to fill out the SC Preauthorization Request Form or SC Referral Request Form and submit to SharedCare for approval.
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