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TOTAL CARE Referrals

August 5, 2011

TOTAL CARE would like to remind our Primary Care Provider (PCP) Offices that when writing referrals, please refer to specialists who are in our Network. We have added our Directory to our website to assist you with identifying our specialists. Our website is http://www.totalcareny.com/ . An out of Network provider may be used only when an in Network specialist is not available. If you need to use an Out of Network provider, the services need to be pre-authorized by the TOTAL CARE Quality Assurance/Utilization Review Department(QA/UR). QA/UR may be reached at (877) 872-4716.

NPI numbers of all of our Network providers can be found in our Directory. It would be helpful to place the referred to providers NPI number in the block labeled Specialists Provider Number. This will expedite the processing of the referral forms and eliminate errors.

We have found that some PCP Offices are still writing referrals for Physical, Speech and Occupational Therapies, this is no longer required. The therapy office that is providing the service is responsible for obtaining pre-authorized visits after the 8th visit. In addition, no PCP referrals are required for Mental Health services. The mental health provider is responsible for obtaining pre-authorized visits after the 4th visit. For Family Health Plus and Child Health Plus Members, outpatient substance abuse services continue to require a referral.

Your cooperation is always appreciated. Thank You. If you have any questions regarding this matter, please contact our Provider Relations Department at (877) 872-4716