Referrals

90.4 – Referrals (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) PFFS plans may not require members to obtain referrals in order to receive medically necessary, plan-covered services. If a member receives a medically necessary, plan- covered service from a qualified provider, without a referral or prior authorization from the plan, the PFFS plan must pay for the service.