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The document is a Texas Referral/Authorization Form for CFHP Health Services, requiring detailed patient and provider information to process referrals for medical services. It emphasizes the need to verify member eligibility and covered benefits, outlines various referral types, and includes sections for specific services requested and clinical history. The form also contains a confidentiality notice regarding the privileged information it holds.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does Texas Medicaid require a referral?

For most services, if you are enrolled in the HealthSelect of Texas medical plan, you need to get a referral before you get most medical care from anyone except your PCP.

What is the difference between authorisation and referral?

A referral is an order from your PCP to see a specialist or receive certain medical services from some providers. Your PCP helps make the decision about whether specialist services are necessary for you. Prior authorization is approval from the health plan before you get a service or fill a prescription.

Does Texas Medicaid require prior authorization?

Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

What is referral certification and authorization?

The referral certification and authorization transaction is any of the following: A request from a health care provider to a health plan to obtain an authorization of health care. A request from a health care provider to a health plan to obtain authorization for referring an individual to another health care provider.

Is a referral prior authorization?

Although the term referral is often used interchangeably with prior authorization, they are not the same thing. While a prior authorization requests coverage for a medication, service, or treatment, a referral requests coverage for a specialist visit or for specialized medical service.

What is authorization request form?

What is an Authorization Form? An authorization form is a document that is duly endorsed by an individual or organisation which grants permission to another individual or organisation to proceed with certain actions. It is often used to grant permission to carry out a specific action for a fixed period of time.

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