Emergency Department Referrals for Ophthalmology Services


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.