PDF Version
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.
Process
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.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2022
American Medical Association
and © 2022 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.