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PCN Referral Criteria Guidelines

As the Primary Care Physician (PCP), your office is required to make referrals for specialty visits and emergency room visits for patients with the Alabama Personal Choice benefit plan. Patients are instructed to contact their PCP prior to all specialist visits. For emergency room visits, patients must notify their PCP within 48 hours of the service date. The PCP should issue referrals for medically necessary emergency room visits only. Referrals may not be given after patients have received elective specialty care or if the emergency care was provided more than 48 hours prior to PCP notification. Referrals should be submitted electronically to Blue Cross and Blue Shield of Alabama within 72 hours of the effective date of the referral.

Last Updated March 2010