Member Resources

Referrals & Pre-Approvals

The doctor who refers you will work with you to choose a specialist and let you know if you need pre-approval (prior authorization) or whether you can make the appointment directly.

Referral If you need a specialist for your care, your PCP or another specialist will give you a referral to one. A specialist is a provider who focuses on one type of health care service. Download the Referral and Service Request Form (English)

Pre-approval (prior authorization) For some services, your PCP or specialist will need to ask Community Health Plan of Imperial Valley for permission before you get the care. Download the Referral and Service Request Form (English)

Community Health Plan of Imperial Valley makes sure the care is medically necessary. This is called asking for pre-approval or prior authorization.

Your PCP or specialist will work with Community Health Plan of Imperial Valley to get the pre-approval (prior authorization).

Getting a pre-approval may take 5 days or up to an additional 14 days if we need more information from your PCP. If urgent, it will take no more than 72 hours. 

Please refer to your Member Handbook for more information and a complete list of services that require a referral or prior authorization.

The information can be found under Section 3 – How to get Care: Referrals and Section 3 – Pre-Approval (prior authorization).