June 3, 2025
We’ve simplified our Limited Cost-Sharing Referral form used by Indian Health, Tribal and Urban Indian facilities to refer members who are on limited cost-sharing plans to a non-I/T/U provider.
What’s changed: We removed the referral provider information from the medical referral section on the front page. This means an I/T/U facility only needs to submit one referral per patient. The referral is good for all covered services for the entire year. We also updated the contact fields for the I/T/U facility to add the facility name and email address.
Tip: Please complete all form fields to avoid processing delays.
Background: American Indians and Alaska Natives on limited cost-sharing plans can get treatment from Indian health care providers at Indian Health Service, Tribal and Urban Indian facilities. But if they need services unavailable through I/T/U facilities, they can get care from a different provider without paying anything out of pocket, if they have a referral.
Prescription reminder: Pharmacy claims are processed when a member fills the prescription at the pharmacy. Members may have to pay out of pocket for prescriptions filled without an I/T/U referral.