In December we posted two articles regarding changes effective January 1, 2019 to our Individual Pathway Networks and a new Network called Blue Access.   Both these networks have Gatekeeper models which involves the member choosing a PCP and referrals are needed to see most specialists.


Early claims may not have been impacted. Moving forward please be advised that claims submitted without necessary referrals will be denied according to our agreements and the member will be held harmless. Our  Managed Care Referral Form can be found on > Find Forms > General Forms.


Please contact the number on the back of the member’s card if you have any questions or concerns.


The attached table indicates Gatekeeper plans that currently require a referral.


Featured In:
April 2019 Empire Provider Newsletter