Global referral: What it allows a specialist to do

A global referral allows a specialist contracted with Blue Care Network to perform necessary services to diagnose and treat a member in the office as long as those services do not require prior authorization or benefit review. The specialist may also order diagnostic tests and/or schedule elective surgery at a facility as long as those services fall within the date range of the global referral; however, plan notification and prior authorization rules apply.

A separate request must be submitted by the specialist, primary care physician or facility for services requiring plan notification or prior authorization. Without plan notification or prior authorization, when applicable, claims for services at facilities will not pay against a global referral.

Reminder: Only primary care physicians can request global referrals for their members.

Please see the BCN Referral and Clinical Review Program for additional information about global referrals.