Specialist-to-specialist referrals for the same episode of care

Some referrals may be authorized from one specialty care provider to another, bypassing the need to get another PCM referral.

Specialist-to-specialist referrals:

  • Apply only when a valid evaluate and treat referral from the PCM was previously authorized for the same episode of care
  • Do not apply to Active Duty Service Members (ADSM)
  • Are subject to the military hospital or clinic ROFR policy
  • If you are a specialist referring your patient to another specialist, please keep in mind:
    • You, the receiving specialist and the PCM will be notified of all such referrals by automatic fax, keeping the entire care team aware of these clinical contacts
    • Not all specialist-to-specialist referrals will be authorized
    • If a pediatric patient age five or younger, or a patient with a developmental, intellectual or physical disability requires dental procedures under general anesthesia, the request for prior authorization may be submitted by the dentist