Patient Resources
Referrals, Denials and Appeals
Understand how referrals to outside providers are coordinated, why denials happen, and how to file an appeal.
Referral Process
See our Patient Rights & Responsibilities for the full policy.
- When referrals are initiated by outside providers, or you have additional visits or tests, the patient has the responsibility to submit the referral information to the referral coordinator to request preauthorization of payment.
- Once preauthorization is obtained, a referral coordinator will assist you in setting up the appointment with the outside specialist.
- Before your initial and each subsequent appointments, please be sure the outside provider has received preauthorization from Yellowhawk.
- If you are unable to keep an appointment or need to reschedule, please notify your referral coordinator as soon as possible. Patients are responsible for any charges incurred from missed appointments.
- If you have additional questions regarding the referral process, please contact your referral coordinator.
Denials
If payment for a medical bill is denied, you will be notified by Yellowhawk. The most common reasons for denial are:
- Ineligibility because of failure to prove you are of American Indian or Alaska Native descent
- Ineligibility because you do not reside within the Yellowhawk service area
- Refusal to apply for and/or use alternative insurance
- Visited an emergency room or urgent care for nonemergent services; did not notify Yellowhawk within 72 hours of an ER visit; or did not follow up with your healthcare provider after an ER visit
- Failure to provide required documents to Yellowhawk (e.g. proof of insurance or other documents)
- Failure to get preauthorization for services to an outside provider and/or facility