Referral Management

The Referral Management Program, through a collaboration of Primary Care Physicians (PCPs), practice staff and NEQCA, is aimed at improving quality, efficiency and network integration through review of out-of-network out-patient tertiary referrals. When clinically appropriate, patients should be referred to Tufts Medical Center and Tufts Children's Hospital. If a PCP requests a patient to be treated outside of the network, this program provides a process for NEQCA to review the referral request and communicate recommendations to re-direct in-network when clinically appropriate. 

 

What type of referrals require review?

Contact Referral Management:

 

In-Network and preferred specialty providers

NEQCA has a comprehensive network of specialists comprised of:

  • NEQCA providers - specialists who are members of NEQCA.
  • Referral providers - specialists who are not members of NEQCA but serve a community of PCPs where there is an absence of NEQCA providers to refer to.

Collectively, these groups represent NEQCA’s in-network providers. 

NEQCA also has Preferred Specialist Criteria. A Preferred Specialist is a status that an in-network provider can achieve by meeting the current Preferred Specialist Criteria. These providers are recognized in the NEQCA network with this differentiating status for consideration in PCP referral decision making. Specialists who meet criteria are indicated on the in-network specialist list.

 

Preferred Specialist Criteria 2021

 

 

 

 

 

 

Facility based specialties excluded from criteria (will show as “exempt” on In-Network Specialist list):

  • Anesthesiology
  • Clinical Pathology
  • Dermatopathology
  • Diagnostic Radiology
  • Emergency Medicine
  • Neuroradiology
  • Nuclear Radiology
  • Pediatric Anesthesiology
  • Pediatric Emergency Medicine
  • Pediatric Radiology
  • Radiation Oncology
  • Therapeutic Radiology
  • Vascular & Interventional Radiology

 

Contact for In-Network Providers:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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