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There are a number of outpatient services included in designated
(capitated) programs for commercial HMO and POS
members. These services are:
- diagnostic radiology*
- short-term rehabilitation*
- laboratory
Primary care physicians (PCP) must refer members to their capitated site for
these specialty services. In addition,
participating specialists
must refer HMO and POS members to the
capitated sites of the member's PCP. The
member's capitated laboratory site is indicated on his/her member ID card. You
may obtain additional specialty site
information for the member's PCP on the NaviNet
® web portal by
using the Eligibility and Benefits Inquiry transaction.
For more information regarding member referrals to capitated sites, please
refer to the Specialty Programs section of
the Provider Manual for Participating Professional Providers.
If you have any questions, please contact your Network Coordinator.
* Radiology and physical therapy services are not
capitated for Keystone 65 Focus Rx HMO (Keystone 65 Focus) members. These
members must be directed to a participating provider in the Keystone 65 Focus
network. Referral requirements still apply
NaviNet is a registered trademark of NaviNet, Inc., an independent
company.
]