Referrals - OneNet PPO Supplement, 2018 UnitedHealthcare Administrative Guide

UnitedHealthcare’s requirements for care provider referrals do not apply to the OneNet PPO Workers’ Compensation Network. Do not use the Referral Submission system online. However, in some states, the injured worker may be required to use certain care providers to receive workers’ compensation benefits.

Please contact the injured workers’ case manager or adjuster for guidance. Use your best efforts to recommend another participating care provider, if requested.

For assistance identifying participating care providers, please call Procura at 877-461-3750.

Air Ambulance, Fixed-Wing Non-Emergency Transport

UnitedHealthcare’s requirement to refer non-emergency fixed-wing air ambulance to a participating care provider does not apply. The injured worker may not receive workers’ compensation benefits unless an authorized care provider is used. Please contact the injured worker’s case manager or adjuster for guidance.

Laboratory Services

UnitedHealthcare’s requirement that participating laboratory providers must be used does not apply. The injured worker may not receive workers’ compensation benefits unless an authorized laboratory is used. Please contact the injured worker’s case manager or adjuster for guidance.

Use your best efforts to refer to a laboratory based on the information provided. The OneNet PPO Workers’ Compensation Network includes national, regional and local care providers of laboratory services. The self-referral and anti-kickback provisions of UnitedHealthcare’s laboratory services protocols apply to OneNet care providers.

Pharmacy Services

The OneNet PPO workers’ compensation network does not include a pharmacy network.

Specialty Pharmacy and Home Infusion

UnitedHealthcare’s requirements on Designated Specialty Pharmacy or Home Infusion Providers for Specialty Medications, and Specialty Pharmacy Requirements for Certain Specialty Medications do not apply to, and are not supported by, the OneNet PPO Workers’ Compensation Network. The exception to this is the provision on Administration of Xolair in a Health Care Setting.

Please contact the injured worker’s case manager or adjuster for the name of a specialty pharmacy provider, as the injured worker may be required to use certain care providers to received benefits.

Behavioral Health Services

If you believe an injured worker would benefit from mental health/substance use services due to their job-related injury, contact the injured worker’s case manager or adjuster. The network includes behavioral health care providers.