5 ROLES AND RESPONSIBILITIES
5.1 The Medicare Advantage Provider Network
Medicare members obtain covered services by choosing a PCP who is part of the network to assist and coordinate their care. Members are encouraged to coordinate with their PCP before seeking care from a specialist, except in the case of specified services (such as women’s routine and preventive care and behavioral health care).
Note: Some services provided by a specialist may require precertification or a referral. All referrals to a provider that are not within the IntegraNet network requires precertification. Please refer to Provider Obligations — Precertification.
When referring a member to a specialist, it’s critical to select a participating provider within our Medicare network to maximize the members benefit and minimize their out-of-pocket expenses. If you need help finding a participating provider, please call Provider Services at 833-908-0105. If you believe you must refer to a provider outside of our network, you must notify IntegraNet in advance of that request in order for an organization determination to be made. Failure to initiate this request may result in claims denials and member liability. This includes such services as laboratories however does not include urgent or emergent services. Please refer to Provider Obligations — Precertification.