Central California Alliance For Health

 

Referrals from Emergency Department to Specialists

In an effort to reduce delays for urgent follow-up care in specific time sensitive clinical circumstances, the Alliance allows direct referral from the Emergency Department (ED) physician to the specialist. In the clinical situations described in the code library, prior authorization is not required for referral to the specialist.


For more information on the referral process, please see Policy 404-1303 - Referral Consultation Request Process.


ED providers may refer directly to the following specialists for the referenced treatments. These do not require a Referral Form or any documentation for payment purposes:


a. Orthopedic Surgeons: for documented or suspected fracture, sprains,
    and strains

    • ED Direct Referral Orthopedic Diagnosis Codes (PDF)

    • ED Direct Referral Orthopedic Diagnosis Codes

b. General surgeons: for chronic cholecystitis (inflammation of the gallbladder)

    • ED Direct Referral Gallbladder Surgery Diagnosis Codes (PDF)

    • ED Direct Referral Gallbladder Surgery Diagnosis Codes

c. Ophthalmologists: for emergency retinal detachment; corneal abrasions, burns
    and retained foreign bodies; acute ocular infections; and glaucoma emergencies

    • ED Direct Referral Ophthalmology Diagnosis Codes (PDF)

    • ED Direct Referral Ophthalmology Diagnosis Codes

Please contact a Provider Relations Representative for help with questions or for more information at (800) 700-3874, ext. 5504.









 


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