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Notification to AmeriHealth Caritas District of Columbia is requested when a primary care provider (PCP) refers a member to a participating specialist. Referrals are valid for 180 days with unlimited visits.

How to submit a referral


To submit an electronic referral:

  • Log in to NaviNet. If your office is not currently using NaviNet, you may enroll online at by selecting Sign Up or via telephone by contacting NaviNet customer service at 1-888-482-8057.
  • Once you log in to NaviNet, select Referral Submission or Referral Inquiry and follow the steps to refer a member or view referrals.
  • For more specific instructions, refer to the user referral materials available under Customer Service on the NaviNet website.

On paper

Referral forms may be requested by contacting Provider Services at 1-202-408-2237 or 1-888-656-2383 or your provider account executive. You may also use the referral supply request form (PDF) to fax in your request.

To submit a paper referral:

  • Complete all requested fields on the referral form and ensure that the form is legible.
  • Ensure the date of service is not prior to the date of the referral.
  • Mail a copy of the referral to the address provided on the Referral Form.
  • Please give a copy of the Referral form to the member to present upon visiting the consulting specialist/hospital or other outpatient facility.

Services that require referrals

  • Allergy testing/injections/serum
  • Diagnostic procedures performed by a specialist in an office setting
  • Dialysis-associated physician services for members without Medicare coverage
  • Diabetic counseling
  • EPSDT-related dental services for children three years of age and older
  • Fracture care
  • Injectables administered during a specialist office visit
  • Nutritional counseling
  • Medically-necessary oral surgery
  • Outpatient diagnostic X-rays
  • Second and third opinions
  • Sleep studies conducted in a specialist office
  • Visits to a specialist, hospital or other outpatient facility
    (except for the direct access services listed below)

Direct access services that do not require referrals

  • Emergency services
  • Immunizations
  • Prenatal OB visits
  • Routine OB/GYN visits and women's preventative healthcare services
  • Routine family planning services
  • Services for sexually transmitted diseases (STDs)
  • Routine dental services

Additionally, AmeriHealth Caritas District of Columbia Medicaid members have direct access to:

  • Routine vision services
  • Initial 10 sessions of outpatient behavioral health counseling and therapy (individual, family, group)