REFERRAL & AUTHORIZATION GUIDELINES
Total Physicians, Hospitals & Others
Inpatient Authorizations: Request authorizations for inpatient services via fax to THC Medical Management at 313-748-1312. Authorization numbers will begin with the letter A
Other Services Requiring Authorization: Request via fax as above. Authorization numbers with begin with the letter R
Referrals: PCPs initiate referrals via the online portal. There is no alpha character for an online referral. Referrals do not require clinical review and approval from Total Health Care. Referrals for covered benefits are not required for:
- Office Visits for in-network specialty providers, with the exception of podiatry and chiropractic
- Services performed within the offices of in-network specialty providers. Providers may treat as needed in office.
Out of Network Services: Prior Authorization Required.
Please Note: You must obtain authorization for therapy services from NAVANT. The referral you have received from the member’s PCP is valid only for the evaluation. You may fax the authorization request form below to (734) 995-0198 or e-mail the authorization to email@example.com.
THC supports Patient Centered Medical Home (PCMH) principles, an approach to providing comprehensive primary care that facilitates partnerships between individual patients, their physicians and families. THC expects our PCPs to direct patient care to appropriate providers with whom they have established relationships and will share care plans. Visit the Provider Search option in the Provider Portal at www.THCmi.com for a listing of contracted specialty provider.
When Referring A Patient
- Provide concise instructions, expectations on scope of referral for both patient and specialty physician, including whether the referral is for:
- Formal consultation
- Co-management of patient
- Provide appropriate reports of prior diagnostic testing (e.g., labs, radiology, medications, progress notes)
- Be available for phone consultations
- Track patient compliance with the referral
- Set boundaries and expectations with patients concerning where and with whom they may access care, emphasizing the importance of the network to coordinate care plans
PCP AND REFERRAL PHYSICIAN SHARE ACCOUNTABILITY FOR PATIENT CARE
- Manage utilization, including avoiding duplication of testing
- Be readily available for urgent requests when coordinating care
- Develop care plans and self-management goals with clear instructions for patient follow up
- Arrange for coverage when unavailable
You may contact THC Provider Relations at 844-THC-DOCS (844-842-3627) for questions or assistance when referring patients for care.