Referrals

Referrals

Referrals

Trusted's Restructured Referral Process 2017

Specialist Referral Process

Effective April 1st, 2017 Trusted will no longer require an electronic referral from our participating PCPs for Trusted's members to access specialty services. Our systems have been configured to adjudicate claims without having to look for the electronic referral. However, we are requiring our Primary Care Providers to send the referral information via a letter, prescription or communicate telephonically with the specialist rendering the services. We are also requiring the specialist rendering the services to adhere to industry standards by including the referring PCP's NPI number on their claims.

If a specialty provider is out of network, and the service cannot be provided in-network, a prior-authorization must be obtained.

Case Management / Disease Management Referral Process

Trusted has a robust Case Management/Disease Management Program to coordinate the care for members with high risk or chronic conditions. Please use the referral form below to refer a member to any of the following programs:

  • Childhood Asthma
  • Renal
  • Diabetes
  • Cardiovascular
  • Respiratory (Asthma and COPD)
  • Social Services
  • High Risk Pregnancy
  • Palliative care
  • Multiple admissions 
  • Multiple Cormorbitities
  • Pharmacy Review
  • Other
Diabetes Disease Management Program

Trusted Health Plan (THP) has a Diabetes Disease Management Program. All THP enrollees aged 18+ with a primary or secondary diagnosis of Diabetes or Pre-Diabetes (with the exception of Gestational Diabetes) is eligible to receive the benefits of this program.  All eligible enrollees will undergo a Diabetes Health Risk assessment and receive education and services customized to their severity of illness.
Benefits of this program include:

  • Disease Management Staff Outreach
  • Educational Materials
  • Educational Seminars and Services at the Health and Wellness Outreach Center
  • Medication and Preventative Health Monitoring
  • Case Management Services and PCP outreach and care coordination are also available to High Risk enrollees.
Childhood Asthma Disease Management Program

THP has a Disease Management Program for Childhood Asthma. All THP enrollees aged 2-20 with a primary or secondary diagnosis of Asthma is eligible to receive the benefits of this program.  All eligible enrollees will undergo an Asthma assessment and receive education and services customized to their severity of illness.
Benefits of this program include:

  • Disease Management Staff Outreach
  • Educational Materials
  • Educational Seminars at the Health and Wellness Outreach Center
  • Medication and Preventative Health Monitoring
  • Smoking cessation classes and support group

Case Management Services and PCP outreach and care coordination are also available to High Risk enrollees.
If you identify a member that would benefit from either of these services, please contact THP at 202-821-1132, or complete the referral form below.

Disease Management Program
  • Referring Physician's Name*
    0
  • First Name*Patient
    1
  • Last Name*Patient
    2
  • Member ID*
    3
  • Member Phone Number*
    4
  • I am interested in learning more about:*select one or more
    Asthma
    Diabetes
    Cardiovascular
    Respiratory (Asthma and COPD)
    HIV/AIDS
    EPSDT
    High Risk Pregnancy
    High Risk Newborn
    Multiple Events (2 + admissions in 6 months, multiple ER)
    Multiple Comorbidities
    5
  • Other*
    6
  • 7
 
Downloadable forms for referrals:
TRUSTED Health Plan (THP)

Your Local Washington D.C.
Managed Care Organization (MCO)

Call Member Services

(202) 821-1100

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