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Referrals

In-Network Provider

Health Tradition: No referral is required when referring to an in-network specialist.

Health Tradition CarePlus plan DOES require a referral to all in-network specialists.*

*NOTE: Audiology, Behavioral Health, Chiropractic, Dental, Dietician, Home Nursing Care, OB/GYN Ophthalmology, Optometry, Oral Surgery and Rehabilitation Medicine (OT, PT, ST) services with in-network providers DO NOT require a referral.

Out-of-Network Provider

A referral is required when referring to an out-of-network provider. Out-of-network provider referrals are approved in limited circumstances.

The referring provider will submit a referral request to Health Tradition for approval prior to a member seeking services with a specialist. Any in-network provider can submit a Referral request.

Please refer to the Provider Forms section for the appropriate Referral Form.

Referral Process

The Referral form is available as a fillable PDF document on the Maddy Provider Portal in the Authorization & Referrals section and on the Health Tradition website at our Provider Forms page.

  • The Referral form will need to have all required fields completed and faxed to the fax number on the form.
  • The Referral request will be reviewed and approved or denied within 15 calendar days.
  • The decision notification will be sent to the member, the referring provider and the referred-to provider.

If a visit with a specialist occurs without a referral all services related to that visit are not covered and the member is responsible for all charges.