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Referrals to Outside Providers

Referrals are made when the needed care is beyond what we have available here at the Health Centers. The provider will begin the referral process and then arrangements will be made through the referral specialist.

  • Referrals for Purchased/Referred Care Services must be authorized at the Health Center by the appropriate health care provider. The provider may be a physician, dentist, mental health or substance abuse counselor.¬†
  • Alternate sources for payment must be identified at the time of referral. (Medicaid, Medicare, or Private Insurance)¬†
  • The referral will then be electronically generated and assigned a unique number and will be placed at patient registration desk for patient to pick up.
  • Lack of compliance with PHC policy by the patient may result in cancellation of any unused referral after 90 days.
  • Authorizations are valid for one visit only. If the outside provider requests follow-up treatment, you will need another authorized PHC referral. Referrals must be requested by the patient 5 business days prior to the appointment.¬†Failure to get another referral may result in denial of payment of your outside charges.
  • Missed appointments will need to be rescheduled by the patient with notification to a referral specialist within 7 days or referral may be cancelled.
  • If you choose to use services of an outside provider, without being referred by a provider of the PHC, you will be responsible for the costs. Outside services are paid through referral only.

After Your Visit Outside the Health Center

(Purchased/Referred Care Services – Eligible Patients Only)

Occasionally, the patient may receive a bill from an outside provider for specialist visits such as x-ray, hospital outpatient procedures, emergency room visits and hospitalizations. In order to notify the outside provider to submit the claim to Purchased/Referred Care Services at the PHC for payment processing, the billing statement must be presented to Purchased/Referred Care Services as soon as it is received. This can be done by bringing the bill into the appropriate Health Center where the receptionist will help you route the bill to the correct office.

Passamaquoddy Health System Programs