Referral/Authorization Inquiry Tip Sheet

Purpose of the Referral/Authorization Inquiry
Referral/Authorization inquiries are used to see if a referral or authorization has been provided to a given patient.

Completing the Referral/Authorization Inquiry Form:

Indicate Payer (Required)
Select payer from the drop-down list.

Requesting Provider (Required)
By using the search box, you can enter information for any of the search criteria option listed including:

Payer ID (Payer assigned provider ID)
Provider Name
Tax ID
NPI
Address
City
State
Zip Code
Taxonomy

You may also want to sort providers using these same options by clicking on the corresponding arrows. Results of your search can be listed in 100 – 1,000. You may also look through pages of entries by clicking the left or right arrows.

Providers must be selected (highlighted in teal).

Referral/Authorization Inquiry Information (Required)
Select Referral Inquiry or Authorization Inquiry.

If Authorization Inquiry is selected, you must select either Admission (inpatient) or Health Services Review. Health Services Review includes all services requiring authorization (referral/preauthorizations) other than Inpatient admissions.

You must specify either:

Member ID, including two-digit suffix and service date in the "From" and "To" date fields
Member ID, including two-digit suffix and Referral/Authorization #, if known

Patient Account Number (Optional)
Enter your patient account number. If completed, the data will be returned on the Referral/Authorization response page.

Click Submit.

If you do not enter the required information, the submit button will be 'greyed' out until all required fields are entered. Click on the "Information" icon for required fields for each section and additional information.

Referral Inquiry Response
If there are multiple referrals for the submitted information, you will need to select the referral/authorization from the presented list and you will then be directed to the Referral/Authorization Inquiry Response page. This page will describe the Referring Provider information, Servicing Provider information, the Member information and the Referral/Authorization Details.

Helpful Hints for All Payers
Referrals to clinics must be made to individual providers, not the clinic or facility.

Payer Specific Helpful Hints

Independent Health
Independent Health allows a 30-day date range search. This will pull back all Referrals / Authorizations for that date range.

The eligibility response, "additional information" section, will indicate if a referral is required for a member at the product level.

When inquiring on referrals or authorizations, the primary address of the specialist will be returned regardless of the service location chosen by the referring physician. Please be advised that this will not impact claims payments in any way.

Univera Healthcare
The requesting provider can either be the referring or servicing provider to obtain referral information.

Chiropractic Referral/Authorization Inquiry requests must be obtained through Palladian Health.

All referrals created through the HEALTHeNET website will be unlimited and will return a modified number of visits to 999.

Downloads

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