Referrals and preapprovals in Kansas
For some Kansas Medicaid services, you’ll need a referral from your primary care provider (PCP) before getting care.
When to get a referral
You’ll need to get a referral from your PCP before:
- Meeting with a specialist
- Going to a hospital for nonemergency care
- Getting certain medicines, tests, and services
Self-referral services
For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.
You don’t need a referral from your PCP for:
- Emergency care
- Family planning services
- Yearly OB/GYN exams and prenatal care
- Behavioral health and substance use disorder services
- Sexually transmitted disease (STD) testing
You may need preapproval for a service
A preapproval is when your doctor asks us to approve a service before you receive it. Your PCP will work with us to get the preapprovals you need.
Your PCP will need to send in a preapproval for:
- Planned inpatient admissions
- Certain behavioral health services
- Certain prescriptions
- Rehabilitation therapies
- Home health services
- Pain management
Have questions?
Check your member handbook or live chat with a representative through the online portal or the SydneySM Health app.