Provider Referral Process
As a MPC Primary Care Physician (PCP) or Primary Specialist Provider (PSP), you are responsible for initiating and coordinating referrals of enrollees for medically necessary services beyond the scope of your practice. If you are a PCP, you also ensure that members you refer to specialists return to your care as soon as appropriate.
Documentation of the referral in the enrollee’s medical charts is required. Additionally, as a PCP or PSP, you should provide pertinent referral information to the participating MPC health professional to whom you refer the member.
A prenatal risk assessment form is required for obstetrics services. Please complete the form and mail or fax it to our Case Management department immediately upon confirmation of pregnancy.
If an in-network specialist is not available, we may issue a prior authorization for a referral to a noncontracted provider. Please note that a noncontracted provider will not be reimbursed without a prior authorization.
A prior authorization may still be required for services. Check the prior authorization grid or contact MPC for details or with any questions.