Cascading Referrals


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TO:    All Providers


RE:   Cascading Referrals 


Medicaid providers have the option to issue cascading referrals. A cascading referral is a referral that can be continuously forwarded to additional providers until the recipient’s condition has been rectified. The Primary Care Provider (PCP) or EPSDT screening provider may refer the recipient to another provider for other diagnosed conditions. Due to the existence of the cascading referral, the second and subsequent providers may refer the recipient to another provider without having to obtain an additional referral from the originating PCP or EPSDT screening provider. The original cascading referral may be used until the recipient’s condition has been rectified or the referral expires.



The original cascading referral is generated by the PCP or EPSDT screening provider if the provider determines a recipient should be referred to another provider for care related to other diagnosed conditions. It is the PCP’s or EPSDT screening provider’s responsibility to provide a copy of the referral form (Form 362) to the second provider with ‘cascading’ indicated on Form 362. The cascading referral permits subsequent providers to refer the recipient to additional providers without a having to request a new referral. This process is continued until the condition(s) have been rectified or the referral expires. A new approval/EPSDT screening must be provided anytime the diagnosis, plan of care (care plan, plan of treatment, treatment plan, etc.), or treatment changes. The provider must contact the PCP or EPSDT screening provider for a new referral/screening at that time.


Benefits of Cascading Referral:

  • Allows continuity of care for the recipient
  • Saves time for the provider and the recipient
  • Encourages collaboration among providers to ensure the recipient receives quality care

Reminder: during the Public Health Emergency, EPSDT referral requirements have been waived. A subsequent ALERT will be issued when EPSDT referral requirements resume.


For more information on cascading referrals, refer to Appendix A of the Alabama Medicaid Provider Billing Manual.

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