Common use of Standing Referrals Clause in Contracts

Standing Referrals. Consistent with utilization management, or unless otherwise set forth by statute, regulation or the Health Benefit Plan, Covered Individual shall be allowed to receive a standing referral, as defined in CRS ▇▇-▇▇-▇▇▇ (64), for Medically Necessary treatment, to a specialist or specialized treatment center who is a Network/Participating Provider. The primary care physician for the Covered Individual, in consultation with the specialist and Covered Individual, shall determine that the Covered Individual needs ongoing care from the specialist in order to make the standing referral. A time period for the standing referral, not to exceed one (1) year unless authorized by Plan, shall be determined by the primary care physician in consultation with the specialist or specialized treatment center. The specialist or specialized treatment center shall refer the Covered Individual back to the primary care physician for primary care. Treatment provided by the specialist or specialized treatment center must comply with all provisions of the Covered Individual's Health Benefit Plan. The primary care physician shall record the reason, diagnosis or treatment plan necessitating the standing referral.

Standing Referrals. Consistent with utilization management, or unless otherwise set forth by statute, regulation or the Health Benefit Plan, Covered Individual shall be allowed to receive a standing referral, as defined in CRS ▇▇-▇▇-▇▇▇ (6443.5), for Medically Necessary treatment, to a specialist or specialized treatment center who is a Network/Participating Provider. The primary care physician for the Covered Individual, in consultation with the specialist and Covered Individual, shall determine that the Covered Individual needs ongoing care from the specialist in order to make the standing referral. A time period for the standing referral, not to exceed one (1) year unless authorized by Plan, shall be determined by the primary care physician in consultation with the specialist or specialized treatment center. The specialist or specialized treatment center shall refer the Covered Individual back to the primary care physician for primary care. Treatment provided by the specialist or specialized treatment center must comply with all provisions of the Covered Individual's Health Benefit Plan. The primary care physician shall record the reason, diagnosis or treatment plan necessitating the standing referral.