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Overview of Referrals and Prior Authorizations

Referring patients for office-based Specialty Care has never been easier when using the HCP Preferred Specialist Network.

HCP’s Preferred Specialist Network includes thousands of experts from across of 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, preferentially providing care in the most cost-effective settings (generally outside of a hospital system), and have agreed to work closely with all of our PCPs to provide great care to our patients.

Referring to a PSN provider is easier than ever. Choose a provider and tell your patient. HCP can even help make appointments for you should you need assistance. No referral needed, no auth number needed. (NOTE: EmblemHealth Cohort 2 members require HCP Notification by the PCP to ensure payment).

Most services performed in a PCP office and in a PSN Specialist office no longer require Prior Authorization. Why? 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 keeping your patients healthy, rather than spending time with the administrative burden of in-office Prior Authorizations.

Prior Authorizations, when they are required, are quickly and efficiently completed to save time and avoid delays. New transparent processes are in place to assist you and your members to get the right care in the right setting at the right time.

HCP staff are at the ready to help facilitate the urgent needs of members supporting our Real-Time-Resolution™ line. Call for urgent needs when delays will clearly impact a patient’s outcome – find a specialist who can see a patient today, speak with a Medical Director in consultation, find alternative cost effective sites of care. For non-urgent needs, our processes are faster and easier to use. Review our Website to learn about the best ways to work with us.

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

*Additional care partners for Cohort 2 members include eviCore for radiology authorizations, OrthoNet for spine and pain management care, and Optum for organ transplant evaluations.

Schedule a call with one of our HCP Medical Directors for a curbstone consultation or to complete a Peer-to-Peer discussion to 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 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 underutilization of services. 

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