Referral Tracking

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Health Net's participating providers are required to monitor referrals that have been authorized for medically appropriate care to ensure that the member accesses care and follows up with his or her primary care physician (PCP).

Participating physician groups (PPGs) delegated for utilization management (UM) functions are responsible for tracking referrals authorized for members assigned to PCPs within the PPG's network. The PPG is also responsible for following up with the member and PCP to ensure that the member receives a new referral for the previously authorized services if the services are still required. For additional information, refer to the PPG Responsibilities for Referral Tracking discussion under the Provider Delegation topic.

PCPs are responsible for maintaining continuity of care for Health Net members during the referral process. This entails the monitoring of referrals made for Health Net Medi-Cal members to ensure that appropriate services are accessed and pertinent specialty service reports are received for inclusion in the primary care medical record. Refer to the Care Continuation discussion under the Utilization Management topic for additional information.