Norman Regional Health System offers its employees a unique health plan known as the Coordinated Care Plan. As an NHealth provider, you might see these Coordinated Care Plan members in your practice. When these patients need services outside of the NHealth network, a referral is required. Authorization will only be given for those services which are truly not available in the NHealth Network.
A Care Coordinator will review the request and approve for pre-defined cases. The NHealth Medical Director will grant overall approval as well as approval for more complex cases.
If a request for a referral has been denied, the NHealth provider who requested the referral may work with the Coordinated Care Plan member to appeal the denial. The form can be submitted to the Care Coordination team for review.