WellMed Referral Waiver - Zephyr Update 

You should have received a communication from WellMed regarding updates to the referral authorization process and workflows on August 15 via the Catalyst Connection. If you did not please click HERE to review this now.

WellMed has made the decision to expire their referral authorization waiver effective 10/1/2024. Below you will find helpful FAQs to help guide the transition, as well as these quick tips to assist with sending referrals via LeadingReach. 

What does this mean?

Referral authorizations will now be required and beginning 10/1/2024, all Primary Care Providers (PCP) who manage any WellMed patient should begin to issue referrals for specialty care. WellMed has sent out a communication to all PCP and Specialists that are contracted and affiliated with WellMed about this change.

What do I need to do?

As a Catalyst Health Network member, if you are currently using LeadingReach and the recommended workflows for plan utilization, you are already in compliance with the changes and expectations for referral authorizations.

You do NOT currently need to link your existing LeadingReach account with the Zephyr account/portal at this time. You should simply provide the LeadingReach referral ID that is generated when you create and send a referral via LeadingReach to the specialist.

What if a specialist does not understand the process or states they need a referral authorization number?

We recommend that after you have sent a WellMed referral via LeadingReach, in that referral send a follow up message in LeadingReach and provide the specialist with this link to attend the WellMed Zephyr/LeadingReach training. In addition, provide them with the WellMed Referral Communication and the WellMed Letter documents in the referral as additional resources to assist them with understanding the changes.

Do I need to add any additional information to the LeadingReach referral?

The overall process is that the specialist should use the referral ID created by LeadingReach. This can be found under the referral details on every referral processed in LeadingReach.

The specialist will use this in their claims, and this serves as the referral authorization.  

The process additionally states that each referral is good for 12 visits within a 12-month period. This can be added to the referral as optional notes.