Provider Manual
8 Health Care Management Services
8.1 Self-Referral Guidelines
Medicare members may self-refer for the following services:
Except for emergent or out-of-area urgent care and dialysis services, in general, Medicare members must obtain services within the IntegraNet network or obtain a precertification for covered services outside the network. As a contracted provider with the plan, you are responsible for either referring within the network or obtaining prior authorization from the plan.