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Can a Precertification go through iEXCHANGE without a Referral to the specialist if one is required?

April 26, 2017iexchange Precertification referral specialist

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Can a Precertification go through iEXCHANGE without a Referral to the specialist if one is required?

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No. If a Referral is required, i.e. HMO Blue Texas, the Precertification will not go through. If the Referral is optional, i.e. BlueChoice POS, the Precertification will go through but out-of-network benefits will apply. For BlueChoice PPO, a Referral is not required.