Referral Authorization

 

Determines appropriateness of specialty referrals by primary care physicians.

American Health’s Referral Authorization product allows clients to position primary care physicians as gatekeepers.  The precertification process facilitates steerage to in-network providers.  Clients receive detailed activity reports that track primary care physician referral patterns.

 

Fast Facts

• American Health’s Referral Authorization provides documentation and tracking of specialty referrals as well as reports detailing the number of specialty referrals by PCP, patient diagnosis and type of specialty referral.
• The Referral Authorization product integrates with American Health’s other managed care products, providing an efficient, coordinated program.

Medical Director and Panel of Specialists

Overseeing the Utilization Management program is a Medical Director certified by the American Board of Quality Assurance and Utilization Review Physicians.  The program also offers the expertise of American Health’s own panel of board-certified, practicing physician specialists, in addition to external panels of more than 600 specialists.