5 ROLES AND RESPONSIBILITIES
5.3 The Specialist Role
A specialist is any licensed provider (as defined by Medicare) providing specialty medical services to members. A PCP may refer a member to a specialist when medically necessary. Specialists must obtain authorization from IntegraNet before performing certain procedures or when referring members to noncontracted providers. Please refer to the Summary of Benefits or EOC documents for each health plan for those procedures requiring precertification. You can review precertification requirements online at www.InetDr.com or the health plan’s website.
After performing the initial consultation with a member, a specialist should:
If the specialist needs to refer a member to another provider, the referral should be to another IntegraNet provider. Any referral to a nonparticipating provider will require precertification from IntegraNet. Please refer to Provider Obligations — Precertification.