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Reminder: Referrals have been removed for Medicare Advantage HMO members

January 2, 2018

As previously communicated, effective for dates of services on or after January 1, 2018, we no longer require any Medicare Advantage HMO members to obtain a referral from their primary care physician (PCP) when they need to see an in-network, participating specialist. This includes all Keystone 65 Focus HMO, Keystone 65 Preferred HMO, Keystone 65 Select HMO, and Keystone 65 Basic HMO members.

If an attempt is made to submit a referral through the NaviNet® web portal for a Medicare Advantage member after January 1, 2018, the following message will appear:

Please note that PCPs are still required to direct Medicare Advantage HMO members to their capitated site for certain services (i.e., laboratory, radiology, occupational therapy, and physical therapy).* In addition, providers are still required to obtain precertification/preapproval for certain services prior to rendering services for all Medicare Advantage members.

Attention specialists

As of January 1, 2018, you no longer need to check NaviNet to confirm that a referral is on file for Independence Medicare Advantage HMO members prior to rendering services. Please note, however, that you may still see some referrals on file for these members that were issued prior to January 1, 2018, as referrals are valid for 90 days.

Keystone 65 Focus HMO members

Even though a referral is no longer required for in-network, participating specialists, it is important to remember that Keystone 65 Focus HMO members must receive services from providers who participate in the Keystone 65 Focus defined-network. To find Keystone 65 Focus-participating providers, you can use the Find a Doctor tool by selecting Keystone 65 Focus from the health plans drop-down menu. There are also transactions available in NaviNet to help you locate these providers. Select Reference Tools from the Independence Workflows menu and then either Network Facility Inquiry or Network Provider Inquiry to perform a search.

For more information

For additional information on the facility or provider inquiries using NaviNet, please review our Network Facility Inquiry Guide or Network Provider Inquiry Guide, which can be found in the NaviNet Resources section.

*Keystone 65 Focus members must be directed to their PCP's designated (capitated) laboratory outpatient provider.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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