Provider News and Updates

Elimination of PCP referral requirement


As you may know, earlier this year Prominence established a policy where Medicare Advantage members were required to obtain a primary care provider (PCP) referral prior to seeing a specialist. Our intent with this change was to emphasize and support the critically important role that the PCP serves in providing quality of service and care coordination.

However, the feedback we received was that this policy produced some unintended consequences.

Based on your response, effective immediately, Prominence has terminated the referral requirement for our Medicare Advantage members. We apologize for the challenges this may have caused.

In support of this change, we will reprocess all claims that may have received a denial for no referral on file.

We remain steadfast in our belief that the PCP should serve as the central role in the management of individual healthcare. To that end, we have initiated a robust care coordination department that will be dedicated to that effort. Our team of coordinators will help to ensure the PCP has the needed information and support to best manage the clinical care of our members.

Please contact your Prominence provider relations team at 775-770-9270 with any questions.