In order to ensure the provision of timely services in urgent or emergent situations, the Alliance offers referrals for certain conditions directly from the Emergency Department without referral from a PCP. Effective immediately, the Alliance is now offering Ophthalmology referrals directly from the Emergency Department to Alliance contracted Ophthalmology providers for specific, high-risk, urgent and emergent conditions. No PCP referral is required.
As an Ophthalmology provider, you may see members without a referral from the PCP when an urgent or emergent need is identified.
Conditions that meet criteria for direct referral to Ophthalmology without PCP referral include:
- Trauma, foreign body, or burns to the eye
- Eye Infections (severe or vision-threatening)
- Acute angle-closure glaucoma
- Retinal detachment
- Corneal transplant infection, failure or rejection
Please reference the code set that identifies qualifying claims in the Provider News section of the Alliance provider website at www.ccah-alliance.org/providers.html.
If you have questions, please contact a Provider Relations Representative at (800) 700-3874, ext. 5504.