How will I know which code requires a referral and which does not?
To determine which service requires an approved referral, providers should refer to the Prior Authorization List. This list will detail all active procedures and identify whether or not a referral is needed; however, if a code is not on the list, an authorization is required. The Prior Authorization List has a column titled “Prior Auth Required”. If the column indicates:
- No - An authorization is not required provided the service meets all other criteria and rules
- Yes - An authorization is required
- Not Covered - Service is not a covered benefit and the member must be advised of their financial responsibility if the member still desires the service.
The Prior Authorization List is available on the Provider portal on the Working with HAP tab. The list will be updated monthly and you are encouraged to reference the list online prior to rendering service