Documents and Forms

Provider Manual: Authorization and referalls web portal users guide
Referral Authorization Form: Medicaid & Alliance
Changes in Authorization Process


1. All consultation services for any Health Right, Inc. in-network specialist is allowed (3) visits within a 6-month period without an authorization number for referrals. After the 3 visits, an authorization number is required. The Health Right Referral Form is given to the member to take to the specialist and a copy of the referral still needs to be faxed to HRI UM Department for notification purposes only. Please fax the referral form to 202-289-6964.

2. Members can still self refer for the following services: family planning, vision, dental care, and OB/GYN care. The physician must be in the Health Right network.

3. What does not require an authorization number:

• Mammograms
• Regular X-rays
• Ultrasounds/Sonograms
• Annual routine eye exams
• Routine labwork

The members still need a referral form when they go to obtain these services. However, you do not need to fax the referral form to Health Right. These services will be paid without an authorization number.

4. What requires an authorization number:

• A prenatal packet containing important information about having a healthy baby
• Assistance and support throughout the pregnancy


Click here for: Authorizations and Referrals