Provider Referral Information
Download the Provider Referral Form above, and Provider Specialty/Location Reference Sheet above. Print and fill out the Provider Referral Form, then fax to us at 704-405-4091.
Referral Phone: 704-367-8138
Referral Fax: 704-405-4091
Fax for all other forms/records: 704-405-4093
Thank you for trusting Horizon Eye Care (HEC) physicians with a consultation, treatment, or with the surgical care of your patient. We are committed to making this relationship successful from your patient’s perspective as well as yours.
HEC’s referral center is connected to all six locations and can provide you with the best personalized care for your patient, including urgent care, triage and scheduling referral appointments.
What information do we need from you?
1) Emergency: For patients who need to be scheduled the same day, you must call 704-367-8138 while the patient is still in your office, in case additional instructions may need to be given before treatment or surgery can be performed.
2) Other referral options:
- Call the referral line at 704-367-8138
- Fax the referral form to 704-405-4091. Note: When faxing the form, HEC’s team will contact your patient for an appointment within 48 hours.
- Electronic referrals: HEC is accredited with "Direct Trust"
- Continuity Care Documents (CCD) or Transition of Care (TOC) and additional attachments can be electronically sent to HEC. Note: All practices, with the exception of Novant Health practices, will still need to fax patient’s medical insurance along with your direct fax number for a confirmation letter of appointment made.
3) Required Information: (also found on HEC's Provider Referral form)
- Referring provider’s name, address, phone number, practice name, email address and NPI number
- For appointment confirmation HEC must have provider’s direct fax number
- Optional: Name of HEC physician and the location (HEC’s team can advise if needed)
- Referral priority request: Emergency (same day appointments) must be called in, Urgent (within 7 days), or next available appointment
- Most recent patient demographic information and date of birth
- The “Meaningful Use Act” requires information on race, ethnicity, gender and language
- A copy of the medical insurance card, front & back side and if applicable vision plan insurance
- If the patient is not primary on insurance; insurance subscriber’s name and date of birth
- If an insurance referral is required, the patient’s PCP (listed on the card) must issue the referral, prior to the patient’s appointment. Included must be the approved date range and number of visits allowed
- Copy of exam notes with the diagnosis and a list of all current medications
4) HEC will accept your demographic sheet, in place of HEC’s referral form and it can be attached to the notes, but only if all the above required information is included.
5) After selecting a referral option; fax only notes pertinent to this appointment request to the referral fax at 704-405-4091
Note: In the eye care field, patients can purchase several types of insurance and these insurance plans / policies are very different.
- Vision Plan Insurance can cover parts of a comprehensive good health/wellness vision screening exam, also called routine eye exams, or refraction testing (how the eye sees). This exam can detect refractive errors such as astigmatism, hyperopia, myopia, presbyopia and some eye diseases, but these plans do not cover eye treatment or surgery. A vision plan can cover some of the cost for glasses or contact lenses.
- Medical Insurance policies are needed for treatment of serious eye diseases and surgery. Some plans do cover comprehensive good health/wellness screenings, also called routine eye exams, or refraction testing (how the eyes see). Note: Some policies require a referral from the patient’s PCP (listed on the card) prior to the patient’s appointment.
- Medicare Benefits and Supplement Insurance policies do not cover comprehensive good health/wellness vision screening, also known as a routine eye exams, or refraction testing (how the eyes see). Both Medicare and Supplement policies are used for treatment of serious eye disease and surgery. Some policies do require the patient’s PCP (listed on the card) to issue a referral prior to the patient’s appointment.
What information will the referring providers receive from Horizon Eye Care?
1) Letter after initial consultation:
- Should receive within seven business days of consultation.
- Depending on the type of consultation the letter will include: confirmation of findings, dates for treatment, or surgery and goals when required.
- Letter after surgery if required.
2) Medical Record Requests:
- HEC will release pertinent protected health information including office notes, labs, testing reports and surgical records.
- HEC’s office notes may be released to the referring physician without a record release authorization from the patient (when the provider is noted in HEC’s system). If another physician (not the referring physician) requests office notes an authorization from the patient is required.
Horizon Eye Care contact information at 704-365-0555
Referral Center Manager: Ellen Porter Ext 4148 or Direct 704-405-4148
Clinical Manager & NextGen System Specialist: Amy Brogdon Ext 4156 or Direct 704-405-4156
Medical Records Coordinator: Sasha Manning Ext 4191 or Direct 704-405-4099
Manager of Surgery Scheduling & Surgical Coordinators: Cheryl Sims Ext 4127 or Direct 704-405-4127
Professional Relations Coordinator: Monica Nayar Ext 4224 or Direct 704-405-4100
This is a general guideline for referring providers and their staff, so both practices and subspecialties can partner in providing quality care for our patients. Thank you for choosing and trusting Horizon Eye Care with your patient’s care and please contact us if you have any questions.