Self-referrals are services you can arrange for yourself without first calling your PCP. You must see an AmeriHealth Caritas Northeast network provider for these self-referred services. Services that do NOT need a referral or prior authorization are:
- Prenatal visits
- Routine obstetric (OB) care
- Routine gynecological (GYN) care
- Routine mammograms, with a prescription
- Routine family planning services **
- Routine dental services, if you are eligible for dental services under the Medical Assistance program*
- Routine eye exams*
- Prescription eyeglasses for members under 21 years of age
- Tobacco cessation counseling sessions**
- First visit with a chiropractor
- First 24 visits for outpatient physical, occupational and speech therapy
- Emergency services **
- DME purchases costing less than $500 that are covered by the Medical Assistance program and with a prescription (see the Prior Authorization )
* You may need to get a referral or prior authorization from your PCP for some specialty care services. There may also be some limitations for self-referrals. If you are not sure if you need a referral from your PCP for a service, ask your PCP or call 1-855-809-9200.
** This self-referred service may be provided by a provider not in the AmeriHealth Caritas Northeast network.