July 28, 2026
The following are specialty care service referral reminders for our MyBlue HMO plan members:
- A specialty care provider who has a valid referral from an assigned in-network primary care provider or a provider who is an in-network OB-GYN can order other services or obtain prior authorization for additional in-network services without approval from the PCP.
- If services are needed from an additional specialty care provider, the preceding specialty care provider must notify the PCP to request a referral for the additional specialty care provider.
- If the specialty care provider orders services and doesn’t have a referral in place, the claim is at risk of being denied. The claim for facility and professional services is also at risk of being denied.
- No referral is needed for professional providers for services ordered directly by a PCP to an in-network facility providing outpatient physical, occupational or speech therapy services.
- The PCP may be an in-network OB-GYN.
Always check eligibility and benefits through Availity® Essentials or your preferred web vendor before rendering services. Reviewing eligibility and benefits before providing services can help ensure accurate processing and timely access to required authorization information.
All providers are encouraged to follow our prior authorization guidelines. Refer to prior authorization lists for information on member procedures that may require prior authorization.
To learn more about MyBlue HMO referrals, refer to our Commercial Provider Reference Manual.
If you have questions, contact your provider relations representative or email us.
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