Authorizations & Referrals

Referral Process

SLV Health’s Referral Department is open during normal business hours and may be reached by calling (719) 587-5769.

If you are an SLV Health employee, refer to MEDITECH for all referrals and authorizations.

Are you a patient checking on a current referral?

If your referral originated at SLV Health’s Primary Care Clinics at Stuart Ave, Antonito, La Jara, or Monte Vista, then our referral specialists can assist you by calling the number above.

If your referral originated at any other clinic, please contact that provider or clinic directly. For a list of SLV Health services click here or visit sanluisvalleyhealth.org.

Are you a patient needing a new referral?

If you are in need of a new referral, contact your provider or clinic directly. SLV Health’s referral specialists are available at the number above. They send and track every referral to and from SLVH’s Primary Care and Rural Health Clinics, including Stuart Ave, Antonito, La Jara, or Monte Vista.

Are you a referring agency?

Referrals to and from SLV Health’s specialty clinics are handled internally by those clinics. Click here for phone numbers listed on each service page.

A central referral team handles all referrals to and from SLV Health’s Primary Care Clinics at Stuart Ave, Antonito, La Jara, or Monte Vista by calling the number above.

LucreciaAuthorization Process

SLVH Authorization Department is open during normal business hours and may be reached at (719) 589-8080.

Some referrals need authorizations from your insurance company, including Medicaid and Medicare, before you seek the next step in your care.

Frequently Asked Questions

What is a prior authorization?

A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device, or procedure.

When does the referral need a prior authorization?

Each insurance plan determines a set of covered services that require pre-authorization. Most PPO (preferred provider organization) benefit plans require the provider to pre-certify inpatient hospital admissions (acute care, inpatient rehab, etc.) while many of them require pre-certification for coordinated healthcare (skilled nursing visits, home infusion therapy, etc.).

Some examples of services that typically require pre-authorization are:

  • MRI/MRAs
  • CT/CTA scans
  • PET scans
  • Durable Medical Equipment (DME)
  • Medications

No pre-authorization is required for outpatient emergency services as well as Post-stabilization Care Services (services that the treating physician views as medically necessary after the emergency medical condition has been stabilized to maintain the patient’s stabilized condition) provided in any Emergency Department.

What is the difference between an authorization and a referral?

A referral is issued by the primary care physician, who sends the patient to another healthcare provider for treatment or tests. A prior authorization is issued by the payer, giving the provider the go-ahead to perform the necessary service.

What do I do if I can’t locate my order?

SLV Health uses an electronic health record (EHR) that houses and tracks your electronic orders (also known as prescriptions) placed by SLV Health providers. For services to be completed in house, a paper copy is not necessary. However, if you ever need a printed copy, that information can be obtained through the ordering clinic or SLV Health’s medical records department.

Who can I contact for help with referrals and authorizations at SLV Health?

Referrals to and from the SLV Health’s specialist clinics are handled by the referring provider’s office. If your SLVH primary care provider has referred you to see a specialist for a consultation, contact SLV Health’s central referrals team at (719) 587-5769 or your primary care provider’s office for more information. The central referral team and specialty offices send the referral information and then work to follow-up in making sure you are scheduled and that the SLVH provider obtains the results to provide the next steps of care.

For all orders for procedures and tests (such as radiology and surgeries) being performed at any of the SLV Health locations, call the authorizations department at (719) 589-8080 during normal business hours and any one of the medical authorization clerks can assist you.

Why do prior authorizations get denied?

A denial is when your health insurance company notifies you that it will not cover the cost of your medication or treatment.

Common reasons for an insurance denial include:

  • Your current care is not deemed medically necessary or appropriate
  • The care is viewed as experimental or investigational
  • Clerical errors like typos or misspellings in the original paperwork or data errors,
  • The doctor you saw was out-of-network
  • Your coverage has lapsed
  • You are no longer enrolled with the insurance company