Advantage Referral WHA’s Advantage Referral Program provides members with access to specialists from the following medical groups, expanding access to specialty care outside of their Primary Care Physician’s (PCP's) medical group: Dignity Health's Mercy Medical Group Dignity Health's Woodland Clinic Hill Physicians Medical Group – Sacramento and Solano Meritage Medical Network NorthBay Healthcare Providence (formerly St. Joseph Health) Can I use Advantage Referral? Members who are assigned to a PCP from one of the following medical groups are eligible for the Advantage Referral program: Dignity Health's Mercy Medical Group Dignity Health's Woodland Clinic Hill Physicians Medical Group – Sacramento and Solano Meritage Medical Network NorthBay Healthcare Providence (formerly St. Joseph Health) How do I use Advantage Referral? While your PCP will treat most of your health care needs, if your PCP determines that you require specialty care, you may request to be referred to any of the specialists who participate in the Advantage Referral program. You can use our online provider search or call Member Services for a list of participating specialists. Note: If you receive care from a WHA network specialist prior to receiving a referral, you may be liable for the cost of those services. How does the referral work? Your doctor will send a written referral to your medical group’s Utilization Management department. A referral takes five days to complete for routine requests and 72 hours for an expedited request. Once the referral is processed you will receive notification with details of your referral. Is prior authorization required? No, Advantage Referrals do not require prior authorizations (pre-approval) since your PCP has established medical necessity by requesting the services of a specialist. OB/GYN services for women and annual eye exams (when covered on your plan) do not require a PCP referral or prior authorization as long as the specialist participates in Advantage Referral. Member Resources Getting Started Find a Doctor Mobile App Register for MyWHA Quick Help Contact Us FAQs Send us Feedback Shop Plans About About WHA Blog Giving Back Careers Other Sites Members Broker CalPERS Employers Providers GRIEVANCE FORM Legal Privacy Terms of Use Non-Discrimination العربية 中文 日本語 Hmong 한국어 русский Tagalog այերեն ارسی Khmer Lao Español Tiếng Việt ภาษาไทย हिंदी ខ្មែរ Copyright © 2021 Western Health Advantage. All Rights Reserved. For the latest Coronavirus (COVID-19), click here: getting care, testing and vaccines