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A primary care physician (PCP) is required to make a referral in the following cases:
Referral notification is not required in these situations:
Referrals for members with the Personal Choice Network (PCN) plan must be submitted online via ProvderAccess. Do not fax original referral forms to Blue Cross for submission of the referral. Referrals to specialists require a 72-hour pre-notification. If a referral is denied, a retroactive referral can be submitted only if it is necessary for a PCN member due to a PCP error. A retroactive referral form must be faxed to Blue Cross referencing why the referral was denied. Referrals may only be approved if the denial is a result of a PCP error.
To view a list of members who have designated you as their PCN physician log into ProviderAccess, choose "Provider Functions," and then select "Review Referral" under the Personal Choice Network heading.