A referral is the process of a Primary Care Provider (PCP) sending a member to another provider, like a specialist, for consultation or services that are not be provided by the PCP.
Some services do not require a Referral Authorization Form and can be accessed by members directly. See "When RAFs are Not Required" in the next accordion below, for this list.
Certain medical procedures require prior authorization to ensure medical necessity and appropriateness of care. CenCal Health makes a list of Procedures Requiring a TAR
available to providers.
Learn more about TARs
Documentation of Medical Necessity for Intravenous Sedation & General Anesthesia for Dental Procedures Referral Slip
CenCal Health members may request a second medical opinion regarding a recommended procedure or service through their PCP. The plan must review the request for medical necessity.
Certain Medi-Cal covered services do not require prior authorization, irrespective of whether the member seeking the service is enrolled in CenCal Health.
- Family planning, sexually transmitted diseases, abortion and HIV testing
- Acupuncture, chiropractic, audiology, physical therapy (Rx may be required)
- Emergency services
To obtain more information about services not requiring prior authorization, please call Provider Services at (805) 562-1676.
Prior authorization for pharmacy services not listed on the CenCal Health formulary is required by the ordering provider.
Prior authorization for high-tech imaging services is required to be completed by the ordering provider.