Frequently Asked Questions
Prior Approval, Referrals, & Speciaists
Prior Authorization - To get some services covered by Medicaid or your health plan, your doctor may need permission first. This is called a prior approval or prior authorization. Most services don't need a prior approva or authorization, but some do. Your doctor's office must get permission before they give you a service that needs a prior authorization. If a request for a prior approvial is denied or not approved, you will receive a letter with instructions on how to ask for a change in the decision.
Referral - A referral is made when you need to see a speciaist. You must get a referral from your PCP to see a specialist or another PCP. Your doctor can refer in different ways:
- by giving you a referral form
- by mailing the speciaist the form
- by calling the specialist.
Specialist - A specialist is a doctor who only works with certain helath problems. Examples of doctors who are specialists are:
- cardiologist - heart
- ENT - ear, nose and throat
- Orthopedist - bone