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Referral requests for capitated specialists


In some of our plans, members are assigned, or capitated, to certain specialists. For example, a member might be assigned to a certain clinic or lab for X-rays or lab services. When you submit a referral for a member using your preferred solution (that is, on our Availity provider portal* or one of our other participating vendors or clearinghouses), be sure to submit the referral request to the correct specialist. (Submit an Eligibility and Benefits Inquiry transaction to see who the capitated specialists are for the member.)


If you submit a referral request for a non-capitated provider, we’ll automatically update it to the correct one.


*Availity is available only to U.S. providers and its territories.

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