Role of Primary Care Providers
Sonder Health Plans values the relationship between a Member and their Primary Care Provider (PCP), a well as supports the role of the PCP as the manager of the Member’s primary, preventative, acute and chronic health care needs. PCPs are responsible for initiating specialist referrals and for obtaining or facilitating any required pre-authorizations.
Role of Specialists
Specialty Providers are responsible for providing quality care for contracted and covered health care services to eligible Members, and for ensuring that any required referrals and/or authorizations have been obtained.
Sonder Health Plans Referral and Authorization Tools & Documents
Sonder Health Plans (SHP) believes that Members should have access to the care they need. Most services under our Plans do not require Prior Authorization by the plan when services are rendered in an office or similar place of service.
Please refer to our Service Specific Referral Not Required List – This list will identify what services a Specialty Provider may render under a PCP’s initial referral for consultation/visit. Any additional services not listed, the Specialty Provider must reach out to PCP to discuss Member record and progress note to obtain a PCP Referral Form prior to proceeding with additional services.
PCPs may use any referral documentation type, such as their own internal referral forms, or script for initial referrals to a Specialty Provider; however, if PCP is referring to a Specialist for services that are NOT listed under our Service Specific Referral Not Required List, a PCP Referral Form must be completed and faxed to 1(888) 217-4320 to notify SHP of the referral.
Faxing this PCP Referral Form indicates to SHP that the Specialist has conducted the required follow-up with the PCP and that the PCP has reviewed the required information and has agreed with the Specialist’s proposed plan of care.
For those services that do require prior authorization, such as elective inpatient procedures, please see our Prior Authorization Request Form for completion and submission per instructions on the form.
Filing Provider Claims
Filing a claim shouldn’t be stressful. We want to ensure providers in our network can get their claims filed easily so you can focus more time on care.
For details on the claims filing process and your responsibilities, please refer to our Sonder Health Plans Provider Manual, section
Availity Payor ID: A0339
Please send all paper claims to:
Sonder Health Plans, Inc.
P.O. Box 3325
Springhill, FL 34611