Do you consider the patients as new patient if they comeback after 1 year or after 3 years? If so, do they require a fresh referral from their PCP/Provider?
For HMO patients, if it's over a year, they have to get a new referral from their PCP if we have not seen them within that year. But, if it's a little over a year, we will make exceptions and pull an authorization for them.
However, If we have been seeing them consecutively throughout the year, they do not need a referral from their PCP.