Referrals and Prior AuthorizationsAs a HealthShare member, you are an active participant in your overall health care coordination. If your Primary Care Clinic (PCC) wants you to see another doctor/specialist about a certain condition you have, this is known as a Referral. Before you see the other doctor/specialist, you must contact HealthShare's Nurse Care Manager to get the Referral approved. If you fail to do so, HealthShare will not pay the bill for the other doctor/specialist, and you will be responsible to pay the entire bill yourself. Certain medical services or tests that are ordered by your doctor may require that you contact HealtShare's Nurse Care Manager for what is called a Priorauthorization. Click here for a list of the services and tests that require you to obtain an approved priorauthorization before receiving the service/test. Other than an emergent situation, if you have one of these services/tests without obtaining an approval from HealthShare first, HealthShare will not pay the bill for that service/test, and you will be responsible to pay the entire bill yourself. If one of these services or tests is a result from an emergent situation and you couldn't contact HealthShare prior to the service/test, then contact HealthShare as soon as possible afterwards. When possible, have the following information ready when you call and allow two to three days for final decision:
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