How do I refer a member to a non-contracted provider?
Referrals to non-contracted providers require additional documentation.
Confirm medical necessity
Referrals to non-contracted providers are approved only when the requested service is not available through a contracted specialist in your region. Document the medical necessity in the member’s chart before initiating the referral request.
Start a new authorization and select Non-Contracted Specialist Referral
Go to Authorizations → New Authorization and select Specialist Referral as the service type. In the provider field, check the box labeled Non-contracted provider. Additional fields will appear.
Enter the non-contracted provider’s information
Enter the referring provider’s full name, NPI number, specialty, and practice address. If the provider is not in the Astrana network directory, you will be prompted to attach a Provider Information Form. This form is available in the Forms & Downloads section of the portal.
Provide documentation of network inadequacy
Upload documentation confirming that the requested service is unavailable from a contracted provider in the member’s service area. This typically includes a list of contracted specialists you contacted and their availability status. Provider Relations can assist you in generating this list if needed.
Submit and await clinical review
Non-contracted referrals are reviewed by a clinical team and typically take 5–10 business days. Urgent non-contracted referrals can be flagged for expedited review — check the Urgent box at the top of the authorization form and include documentation supporting the urgency.