New Claims System Update

Provider Manual
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6 PROVIDER NETWORK INFORMATION

6.5 Urgently Needed Care

Members needing urgent care (but not emergent care) are advised to call their PCP, if possible, prior to obtaining services. However, precertification is not required.

Urgently needed services are defined as those that are covered but are not emergent services and are provided:

  • When the member is temporarily absent from the IntegraNet service area and such services are medically        necessary and immediately required
  • As a result of an unforeseen illness, injury or condition
  • If it is not reasonable given the circumstances to obtain the services through an IntegraNet network provider
  • Under unusual and extraordinary circumstances, services may be considered urgently needed services when the member is in the service area but the appropriate provider within the IntegraNet provider network is temporarily unavailable or inaccessible.