Referrals and Prior Authorizations

HealthShare requires its members to be active participants in their overall health care coordination. Members must contact our Care Manager when their PCP recommends seeing another doctor/specialist and for medical services or tests requiring preauthorization (PDF). However, we will also accept a referral/prior authorization request from a provider if your office chooses to do so on a patient's behalf. When a referral or prior authorization has been approved, or in rare cases denied, the member's PCP along with the specialist and/or facility performing the service or test will be faxed a copy of HealthShare's Determination (PDF sample form).

Our members have been educated that it is ultimately their responsibility to contact HealthShare to obtain a determination on a referral and/or prior authorization. They understand that failure to do so will result in them being fully responsible to pay for the denied bill in its entirety.