Business Process Details - Authorize Referral
Guidance for the Authorize Referral business process that is responsible for referrals between providers that the State Medicaid Agency (SMA) approves for payment, based on state policy. Examples are referrals by physicians to other providers for laboratory procedures, surgery, drugs, or durable medical equipment. The SMA uses this business process primarily for Primary Care Case Management programs where additional approval controls deemed necessary by the state. Most States do not require this additional layer of control.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 01, 2012
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