Referral Process
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Referral Process

To refer a patient, complete the appropriate requisition form and fax to our scheduling department at 866-799-0601 (toll free).  

For Massachusetts referring providers, please see important insurance information below.

Requisition Form - New England Region

Requisition Form - Milton Hospital 

Requisition Form - Phoenix Region 

Please include a copy of the patient’s History & Physical or most recent consult note; and, if your patient has had a previous sleep study at another facility, please include those results as well.

If you are referring a pediatric patient, a Pediatric Needs Assessment must be completed and faxed along with the most recent consult note.

Our staff will contact the patient within 24-36 hours to schedule the appointment and obtain any additional information we may need. Once the appointment is scheduled, we will send confirmation with the date and time via fax to your office. Should the patient change or cancel their appointment, you will also be notified.

We are happy to answer any questions you or your patients may have about scheduling an appointment. Sleep HealthCenters provides referral assistance Monday through Friday from 8:30 – 10:00 PM EST. The toll-free phone number for all patient scheduling and inquiries is 877-SLEEPHC (877-753-3742).

IMPORTANT INSURANCE INFORMATION FOR MASSACHUSETTS REFERRING PROVIDERS: If you are referring a Harvard Pilgrim HealthcareBlue Cross Blue Shield of Massachusetts, Medicare, Tufts Health Plan or Fallon Community Health Plan patient, please see additional criteria below.

 

Harvard Pilgrim Health Care Referrals

Harvard Pilgrim Health Plan has implemented changes to its prior authorization program for sleep studies and sleep therapy. Providers must now request prior authorization for sleep studies and related PAP therapy through a benefits management company rather than through Harvard Pilgrim Health Care. If you have questions about these new regulations, please contact Harvard Pilgrim Provider Services at 800-708-4414.

Sleep HealthCenters can continue to provide sleep services for your patients. Simply check off the Consultation and Management option on the Sleep HealthCenters requisition form and submit as usual. Sleep HealthCenters will manage the process and paperwork.

OR, you can choose to manage the patient yourself by providing the required information to Sleep HealthCenters along with your sleep study referral. This involves completing an eligibility form with information on sleep apnea symptoms, co-morbidities and a sleepiness rating scale. Download HPHC Insurance Bulletin here.  

 

Blue Cross Blue Shield of Massachusetts Patient Referrals

All requisitions must include either a patient’s HISTORY and PHYSICAL (H&P) or CONSULT NOTES indicating specific symptoms that can be attributed to a sleep disorder in order to support the need for a sleep study.

 

Medicare Patient Referrals

Pre-Sleep Study - Medicare requires a FACE-TO-FACE SLEEP EVALUATION prior to a patient’s sleep study in order to provide CPAP or Bi-Level PAP treatment for obstructive sleep apnea. Please click here to download the Medicare Pre-Sleep Study Compliance Form.

 

Tufts Health Plan Patient Referrals

Tufts Health Plan has implemented changes to its prior authorization program for sleep studies and sleep therapy. Providers must now request prior authorization for sleep studies and related PAP therapy through a benefits management company, rather than through Tufts Health Plan. Providers may no longer fax authorization requests for those services to Tufts Health Plan. If you have questions about these new regulations, please contact Tufts Provider Services at 888-884-2404.

Sleep HealthCenters can continue to provide sleep services for your patients.  Simply check off the Consultation and Management option on the Sleep HealthCenters requisition form and submit as usual. Sleep HealthCenters will manage the process and paperwork.

OR, you can choose to manage the patient yourself by providing the required information to Sleep HealthCenters along with your sleep study referral. This involves completing an eligibility form with information on sleep apnea symptoms, co-morbidities and a sleepiness rating scale. Download Tufts Insurance Bulletin here.

 

Fallon Community Health Plan Patient Referrals

To comply with new Fallon Community Health Plan regulations, all requisitions referring patients to Sleep HealthCenters MUST INCLUDE an authorization of services issued directly to the referring Primary Care Provider by Fallon.

Sleep HealthCenters cannot obtain or complete the pre-authorization requests. And, we cannot schedule any patients unless the authorization is sent to our Scheduling Office. Upon receipt of the authorization, we will schedule the patient as soon as possible for the requested services.

If you have questions about these new regulations, please contact Fallon Community Health Plan Provider Services at 888-693-3211.