Referral
A primary provider’s authorization for a patient to see a specialist, required by some plans.
Get a Free Billing AuditDefinition
A referral is a primary care provider’s approval for a patient to receive care from a specialist. Some plans — often HMO-type plans — require a referral on file before they will cover the specialist visit.
A referral is not the same as a prior authorization. A referral routes a patient to a specialist; a prior authorization is the payer’s approval of a specific service before it is provided.
Why it matters for billing
Missing referrals are a preventable denial. Confirming during eligibility whether a plan requires a referral — and that one is on file — keeps specialist visits payable and avoids putting the balance on the patient after the fact.
Related terms
Terms that come up alongside Referral in the revenue cycle.
Billing that gets Referral right
EnVisionMD RCM handles eligibility, coding, documentation, denials and follow-up end to end — so the details behind terms like this one are managed for you, not left to chance.
Request a free billing reviewReferral — frequently asked questions
No. A referral sends a patient to a specialist; a prior authorization is approval of a specific service before it is performed.
It varies — some plans, often HMO-type, require them, so it should be checked during eligibility verification.