Shoestring Valley Holdings โ€” DPC Guide

Submit a Referral to HealthMe

Use the secure form below every time an SVH member needs care outside your DPC office โ€” specialty, imaging, PT, or procedures. Include any records or clinical notes in the form.

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Dual confirmation: Your practice receives an email confirmation the moment the form is submitted. The patient also receives a confirmation that their referral is received and being worked.
โš ๏ธ
All imaging must go through HealthMe โ€” regardless of whether cash-negotiated pricing is available. Imaging can never be referred or billed outside this process.
๐Ÿšจ
PET scans require Prior Authorization before a referral is submitted. Submit PA requests via the Provider Portal or fax (833) 227-4256. Questions: FCH (800) 808-0450.
Referral Workflow
Step-by-Step Process for DPC Offices
1
Patient Needs Outside Care

You determine the patient needs specialty, imaging, PT, or a procedure beyond DPC services.

Imaging โ†’ HealthMe only PET scan โ†’ Prior Auth first DME โ†’ Prior Auth first
2
DPC Submits the Referral

Complete the secure form โ€” upload any records or notes. This is the official handoff to HealthMe Care Navigation.

๐Ÿ“‹ Open Referral Form โ†’ | Fax: 888-522-7313

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Your practice gets an email confirmation immediately. The patient gets a confirmation their referral is being worked.
3
HealthMe Contacts Patient (within 24 business hours)

Our Care Navigation team reviews benefits, finds the right in-network clinic, and coordinates scheduling โ€” all at $0 out-of-pocket to the patient.

4
DPC Notified Once Patient Is Scheduled

Your practice receives an email notification when the appointment is booked.

๐Ÿ“ฌ DPC notified by email at scheduling
5
Patient Attends Appointment โ€” $0 Cost

The visit is fully covered under the active HealthMe referral. Patient pays nothing as long as they follow the care navigation process.

$0 out-of-pocket
6
Patient Calls HealthMe Back After Every Visit

Patient reports what the provider recommended (follow-up, imaging, PT, surgery). HealthMe generates the next referral from this call.

๐Ÿ“ž Patient line: 1-888-488-1551

โš ๏ธ Critical: Even if a clinic gives a follow-up date, the patient must still call HealthMe. A clinic-given date does NOT activate coverage for the next visit.

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Repeat Until Care Is Complete

HealthMe manages the full referral loop โ€” every next step stays at $0 as long as the patient calls back after each visit.

Loop continues until care is fully complete
What HealthMe Handles
Specialty Care Referral Examples
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Network Availability Disclosure: HealthMe works to match patients with in-network specialists in their area. Not all specialties are available in every region, but our provider network is growing every day. Submitting a referral is always the right first step โ€” you will receive a response within 24 business hours confirming availability. Current notes: Cardiology and endocrinology networks are in development (echos can be coordinated). Dermatology is available but currently limited in some areas, including the Pacific Northwest.
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Important Reminder for DPC Offices โ€” Please Share with Patients: Patients sometimes assume that any referral made by their DPC provider is automatically covered at $0 out of pocket. This is not the case. Anything performed outside the DPC office that is not coordinated through the HealthMe Care Navigation team is subject to traditional insurance benefits โ€” including copays, deductibles, and co-insurance. When in doubt, always submit a referral to HealthMe first or call Nurse Dora before sending a patient anywhere.

All specialty care referrals are managed by HealthMe. Here are common examples โ€” submit the form and we coordinate the rest.

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Dermatology

Mole or skin concern requiring evaluation? We connect the patient with dermatology for evaluation and treatment, including any necessary procedures.

โœ” Evaluation + treatment covered under referral
โš  Currently limited in some areas including the Pacific Northwest โ€” submit referral to confirm availability.
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Orthopedics

Rolled ankle, foot injury, or musculoskeletal concern? We refer to orthopedics for evaluation. Most orthopedic consultations include imaging in the same visit.

โœ” Imaging often included at consultation
โค๏ธ
Cardiology

Cardiac evaluations including echos can be coordinated through HealthMe. Full cardiology network is currently in development โ€” submit a referral and we'll confirm what's available in the patient's area.

โš  Maintenance cardiology care is NOT part of the HealthMe $0 program. Subject to traditional insurance โ€” copay, deductible & co-insurance apply.
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Sleep Studies

We perform at-home sleep studies for patient convenience. If a CPAP is needed after the evaluation, the machine is covered. Patient maintains restock supplies locally or through Amazon.

โš  Study must be done with our team. We cannot provide machines to patients our physician did not evaluate.
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Mental Health

Outpatient or inpatient mental health needs? Submit a referral and we match the patient with a provider in our nationwide network and initiate therapy or ordered procedures.

โœ” Outpatient & inpatient covered โ€” nationwide
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Labs

If your DPC office has lab capabilities or an existing lab contract, please run labs through that option first. Only submit to HealthMe if labs are not available through your office or existing contract โ€” we'll coordinate for the patient.

โœ” In-office or contracted labs first โ€” HealthMe coordinates only if unavailable
What Patients Need to Know
Patient Care Navigation โ€” At a Glance
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Even if the clinic gives a follow-up date, the patient must call HealthMe at 1-888-488-1551 to activate the next referral. Skipping this call may result in uncovered charges.
1
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Patient Calls

Calls 1-888-488-1551. HealthMe finds the right clinic.

2
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Referral Created

Patient receives email confirmation. Clinic calls to schedule.

3
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Attends Visit

Fully covered. $0 out-of-pocket.

4
โ˜Ž๏ธ
Calls HealthMe Back

Reports what provider recommended after every visit.

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Repeat

Next referral generated. Process continues at $0.

Mental Health Services
Nationwide Mental Health Network

๐Ÿง  HealthMe Has Mental Health Providers Nationwide

HealthMe maintains a nationwide network of mental health providers for both outpatient and inpatient services. Simply submit a referral โ€” we match the patient with a provider and initiate therapy or other ordered procedures. This is separate from, and in addition to, the EAP benefit through HealthJoy.

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Outpatient Therapy

Individual, couples & family therapy matched to in-network providers near the patient.

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Inpatient Services

Inpatient psychiatric care coordinated through our network when clinically necessary.

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How It Works

Submit referral via the form above. HealthMe matches the patient and starts the care process.

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EAP Also Available

Members also have TalkSpace virtual therapy through HealthJoy EAP โ€” see benefits section below.

Plan Details
Employer Plan & Ancillary Charges

๐ŸขPlan Info โ€” Shoestring Valley Holdings

Plan TypePPO (RBP)
Group ID โ€” Core8300
Group ID โ€” Comprehensive8400
Sponsor in HintHint Connect
Welcome new members by48 hrs of start
Initial appt by90 days of enrollment
Hint questionshintconnect@hint.com

๐Ÿ’ŠAncillary Charges โ€” Covered by Employer

Submit to Hint Connect by the last business day of the service month. Include the member's name.

โœ”Labwork (in-office)
โœ”Medications
โœ”POC tests
โœ”Urgent Care or Procedure expenses
โœ”DME โ€” Durable Medical Equipment (prior auth required)
โœ”Vaccines (if provided in-office)
โœ”OMT โ€” if outside standard DPC sub fee
โœ—All imaging & outside services โ†’ refer to HealthMe
Prior Authorization
What Requires Prior Auth

๐Ÿ”Submit via Provider Portal or fax (833) 227-4256 | Questions: FCH (800) 808-0450

Emergency services do not require pre-auth. Experimental/investigational services are not covered.

๐Ÿšจ PET Scans All Imaging DME, Supplies & Prosthetics Surgery Inpatient Admissions Nerve Ablations Radiation Therapy (SBRT, Gamma/Cyber Knife) Gene / CAR T-Cell Therapy Genetic Testing > $1,000 Hyperbaric Oxygen Air Ambulance (non-urgent) Chemo & Injectables > $7k/year IVIG โ€” All types/brands Blood Clotting Factors โ€” All types Botulinum Toxin โ€” All types Select Hormone Therapy Select Peripheral Nerve Blocks Enteral Formula & Medical Food Select Bioengineered Skin/Amniotic Products
Pharmacy Benefits
Pharmacy Resources for SVH Members

๐Ÿ’ŠPharmacy Options

โ–ธ
PBM โ€” Navitus: navitus.com ยท (844) 268-9789
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Generic Mail Order โ€” GoGoMeds: svh@gogomeds.com ยท (855) 462-9884
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Mail Order โ€” Costco (no membership required): pharmacy.costco.com ยท (800) 607-6861
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International Specialty ($0) โ€” RxManage: Initial fill via Navitus first. Fax: (800) 883-1814
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Specialty Rx โ€” Lumicera: lumicera.com ยท (855) 847-3553
โœ—Out-of-network: Kroger brands (Fred Meyer, QFC), CVS (CVS, Target)

๐ŸŽAdditional No-Cost Member Benefits

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EAP (Financial, Legal, Family) โ€” HealthJoy:
mygroups.healthjoy.com/eap ยท (888) 731-3327
Company: Shoestring Valley Holdings ยท Code: shoestring
โ–ธ
Virtual Mental Health โ€” TalkSpace:
talkspace.com ยท Enroll under First Choice Health
โ–ธ
At-Home Cancer Screenings โ€” Color:
color.com/shoestring
Genetic, colorectal, cervical, prostate, digital skin
๐Ÿ”’ DPC Portal โ€” Coming Soon
We are building a portal for DPC practices to track referral progress and view visit notes. Once we go live, we will reach out directly to practices that want access. In the meantime, referral updates and scheduling notifications are sent by email.
Key Contacts
All Contacts at a Glance
Referrals & Member Issues
Patient Care Navigation
General DPC Questions (Nurse Dora)
Referral Fax
888-522-7313
Prior Auth โ€” Submit Fax
Prior Auth Questions (FCH)

โš ๏ธ Nurse Dora's line is for general questions only โ€” do not use it to submit referrals. Use the form above.