United healthcare primary care physician referral form

UnitedHealthcare Oxford plans

For UnitedHealthcare Oxford plans with alphanumeric Group Numbers

UnitedHealthcare West plans

For UnitedHealthcare West plans simply contact your patient's primary care physician.

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NexusACO Referral Requirements Quick Reference Guide
The UnitedHealthcare NexusACO benefit plans offer UnitedHealthcare commercial members a tailored network of accountable care organization (ACO) care providers. In areas where UnitedHealthcare NexusACO doesn’t have a featured ACO, UnitedHealth Premium® Program designated providers will be included as participating Tier 1 care providers.

Charter, Navigate and Navigate Now Referral Requirement Quick Reference Guide
UnitedHealthcare® Charter, Navigate and NavigateNOW benefit plans offer UnitedHealthcare commercial members a customized, more-focused network of healthcare professionals. Some plans require referrals.

Important Concepts in Integration: Coordination of Care
Members may receive services from more than one practitioner. Coordination of Care among practitioners is a best practice, as well as a vital contribution to integrating a member’s physical and behavioral health needs.  

Home Health and SNF High-Performing Provider Initiative Lists
High-Performing Skilled Nursing Facility and Home Health Provider Initiative Lists

Designated Diagnostic Provider (DDP)
UnitedHealthcare is launching a new benefit design for outpatient diagnostic lab services to help drive patient transparency and manage the cost of healthcare. Outpatient diagnostic lab services will be covered for commercial members at the lowest cost shared when delivered by a Designated Diagnostic Provider.

Skilled Nursing Facilities
These resources are especially tuned to skilled nursing facilities, including brochures for patient education, support for billing and reimbursement, and a special focus on Medicare Advantage and the UnitedHealthcare Passport Service.

EDI 278I: Prior Authorization and Notification Inquiry
Use the Prior Authorization and Notification Inquiry (278I) transaction to check the status of previously submitted authorizations and notifications. Electronic authorization and notification inquiries can be submitted in real-time or in batches and you will receive a unique inquiry ID for confirmation of submission.

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Referral Request Form To request a referral, please have the UnitedHealthcare Community Plan members assigned primary care provider (PCP) complete, sign and submit this form. Fax the form to 8886242748.

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If you are eligible for a rebate or would like to see a complete list of Medicare Provider Fee Schedule items, please send your name, ID and medical records to: State of Arizona — Department of Health Services PO Box 18093 Queen Creek, AZ 86032 For more information, contact: Office of Consumer and Business Services — The Department of Health Services 480 W. Sixth Street Tucson, AZ 85 Telephone — ........................................................1,250 – 5,500 per family, depending upon availability. State of California State of California Department of Insurance P.O. Box 241256 Sacramento, CA 95811 Telephone: ............................................... ...........................1,068 – 4,200 per family, depending upon availability. In Nevada: Office of Consumer Affairs Statewide — In Nevada there is a special fee for referral purposes, with a sliding scale. The total fee will be adjusted each billing cycle based on the actual cost of medical care. The special fee is .01 per service request. This number is valid to anyone who seeks to be referred by the Nevada Department of Health and Human Services. This number is required when the department attempts to evaluate the claims submitted by providers of services or supplies, and is a requirement for all state agencies in the public health service. To request a referral for any of the following services, complete the Form RM1541-1 If the request is for a referral for any of the following services, complete the Request Form RM1541 with the name of the primary care provider of the person seeking a referral. Note: The primary care provider is not eligible for a reimbursement for his or her work or services provided. If the request is for a referral for any of the following services, complete the Request Form RM4511-1 with the name of the secondary care provider (if any). Note: The name of the secondary care provider is not eligible for reimbursement by the Nevada Department of Health and Human Services. To ensure that the request is for a referral as required by state law, the person seeking the referral must complete, sign and fax the completed forms.

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If you do not believe that your request has been successfully assigned, please review the referral request form in your “Referral Request” folder and determine if the form is consistent with the HCA policy in the Referral Policy section above. When requesting another PCP, it must be on the same plan and be assigned to a PCP who is a resident with no known allergies to the patient being seen for the first referral. Note the: Date and Time that his office was scheduled, including the patient's name and any allergies, and the time of the next scheduled appointment Call your PCP, and have him tell you when his office will be open at: Complete the Referral Information Form, and return to the UnitedHealthcare Community Plan to have the referral request filled out. Please note that, upon receipt of your request form, the UnitedHealthcare Community Plan will schedule a new office appointment for the PCP with your requested primary care provider.

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