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Overview of Referrals and Prior Authorizations

HCP’s Preferred Specialists

Referring patients for office-based Specialty Care has never been easier when using HCP’s Preferred Specialist Physicians which include thousands of experts across New York City and Long Island. These high-quality doctors have been chosen for their excellent track record of being strong providers of outpatient care. They have agreed to work closely with all of our PCPs to provide great care to our patients, preferentially providing care in the most cost-effective settings (generally outside of a hospital system).

Referring to a Preferred Specialist

HCP believes that great care is provided in the outpatient setting, and we consider most hospital-based care (both inpatient and outpatient) to be a failure of our outpatient care delivery model to anticipate and provide the care needed to keep people as healthy as they can be. We want to support as much care in the office setting to enable you and your staff to focus on your patients’ health, rather than spending time with the administrative burden of in-office Prior Authorization.

Referring patients for office-based Specialty Care has never been easier when using HCP’s Preferred Specialist Physicians.

Most services performed in a PCP office and in a Preferred Specialist’s office no longer require Prior Authorization. Simply select a provider with your patient using the Preferred Specialist Search Tool. No referral or authorization number is needed! HCP can even help make appointments for you should you need assistance.

Prior Authorizations are Quickly & Efficiently Completed When Required

New transparent processes are in place to assist you and your members in getting the right care in the right setting at the right time.

Facilitate the Urgent Needs of Your Patients

Call the Real Time Resolution™ Line when delays will clearly impact a patient’s outcome – find a specialist who can see a patient today, consult with a Medical Director, and find alternative cost-effective sites of care. 

Ensure you are utilizing our preferred Ancillary Services partners when you need Lab and Pathology Services, Radiology, DME, and Physical Therapy. Use the Quick Links to immediately access the information you need.

Schedule a Call with an HCP Medical Director

Our Medical Directors are available for a curbstone consultation or to complete a Peer-to-Peer discussion which can help avoid unnecessary delays in care.

Important Information on Coverage Decisions

Each day, HealthCare Partners Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on the appropriateness of care and the existence of coverage. 

HealthCare Partners does not reward providers or other individuals for issuing denials of coverage and does not offer financial incentives to UM staff based on decisions that promote the underutilization of services. 

HealthCare Partners is committed to ensuring members have the care and services they need.