Welcome to AllCare IPA!

ANNOUNCING New Referral Process


    • Referrals are now valid for one (1) year with expanded number of follow-up visits based on specialty type.  See below for additional information....
    • Referrals can be generated via use of the three-part Referral Form or online by logging in and choosing the Referral Submission option.
 
 
 
Primary Care Physician Referrals

For the following local, contracted specialties, requests for an initial visit and additional follow-up visits based on specialty type can be requested online as a Referral.  You do not have to submit chart notes with Referrals.


For the following specialties, an initial visit and two (2) additional visits are allowed with a Referrral:


  • Physical Therapy

  • Rheumatology


For the following specialties, an initial visit and four (4) additional visits are allowed with a Referrral:


  • Audiology

  • Cardiology (For Stanislaus County, this specialty is

    capitated to Stanislaus Cardiology)

  • Cardiac Surgery

  • Colon & Rectal Surgery

  • Dermatology

  • Gastroenterology

  • Hand Surgery

  • Hematology/Oncology

  • Infectious Disease

  • Neurology (excluding Pain Management)

  • Neurosurgery

  • Obstetrics & Gynecology

  • Ophthalmology

  • Orthopedics

  • Otolaryngology (ENT)

  • Pulmonary Disease

  • Thoracic & Cardiac Surgery

  • Urology

  • Vascular Surgery


For the following specialties, an initial visit and five (5) additional visits are allowed with a Referrral:


  • Allergy & Immunology (excludes serum)

  • General Surgery (excluding Bariatric)

  • Nephrology

  • Podiatry


For the following specialties, an initial visit and ten (10) additional visits are allowed with a Referrral:


  • Endocrinology


   

Primary Care Physician (PCP) Online Referral Information


Please print out a copy of the Approved Referral and instruct the member to take the Referral with them when seeing the Specialist


IMPORTANT REFERRAL REMINDERS







  • If you are not contracted with AllCare, do not see this patient.
  • REFERRALS cannot be used for Tertiary Level Providers (examples: UCSF, Stanford, Valley Children's)
  • REFERRALS expire one (1) year from date of issue.
  • Additional services/procedures beyond the initial visit and allowed follow-up office visit(s) require pre-authorization by AllCare.
  • PCP REFERRAL is limited to an initial visit and additional follow-up visits (based on specialty type) to the same physician in a 12-month period for the same diagnosis.  Additional visits for the same diagnosis require pre-authorization from the AllCare Utilization Management Department.
  • If only an initial visit is required, please return your report to the referring physician.
  • This REFERRAL is not a guarantee of payment.  Within 2 days before the actual date of service, the Provider MUST confirm with the member's health plan that the member's coverage is still in effect.  AllCare and/or the health plan reserve the right to revoke this authorization prior to services being rendered based on cancellation of the member's eligibility.  Final determination of benefits will be made after review of the claim for limitations or exclusions.
  • Only mid and low level E/M codes should be requested (99243-99241, 99203-99201, or 99213-99211). 
  • For Medicare Advantage members do not use consultation codes (99243-99241); use new patient codes (99203-99201).




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