For those services included on the SHP Quick Authorization Form (QAF) (see the Forms Section of this handbook) a referral is NOT required. Primary Care Physicians (PCP’s) can refer a member to a participating specialist and to many frequently requested services and procedures at free-standing facilities with the Simply Healthcare Plans Quick Authorization Form (QAF) without contacting the health plan for prior authorization.
IMPORTANT NOTE: Communication with the Plan prior to the provision of care is not necessary when using the QAF; however, all inpatient services, outpatient hospital services (including diagnostics), and ASC services do require an authorization
Prenatal care referrals are NOT to be made using the QAF.
**The QAF form is not valid for any inpatient or outpatient hospital services or for any
consultations or procedures not listed on the form, or for out-of-network providers.**
The PCP or specialist ordering the consultation or test is required to fax or mail a copy of the
completed QAF to the participating provider or facility that will be providing the service(s), or
to give a copy to the member so that it is presented at the time of the service
Services that Do NOT Require Prior Authorization or QAF:
Participating Office/free standing laboratory tests at labs consistent with CLIA guidelines
Emergent transportation services
Urgent or emergent care at participating Urgent Care centers or any Emergency Room
County Health Departments (CHD), Federally Qualified Health Centers , Rural Health Clinics and
federally funded migrant health centers when providing:
Family planning services and related pharmaceuticals
School health services and urgent services
*NOTE: If the member receives Family Planning Services from a non-network Medicaid
provider, the Plan will reimburse the provider at the Medicaid reimbursement rate, unless
another payment rate is negotiated.
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