Referral in Medical Billing
A referral is an authorization from a primary care provider (PCP) allowing a patient to see a specialist or receive certain medical services.
Referral in Medical Billing Explained
In medical billing, referrals are often required by insurance plans, particularly HMOs, before a patient can see a specialist or undergo certain treatments. Without a referral, the insurance company may deny coverage for the service.
For example, a patient needs a referral from their PCP to see a cardiologist, which must be submitted with the insurance claim.
Check acronyms and abbreviations in Medical billing glossary.
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