Jan 1, 2020

  • Applicable to all states except NC

Applicable to all states e...
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Referrals, OneNet PPO - 2020 UnitedHealthcare Administrative Guide

Referrals

UnitedHealthcare’s requirements for care provider referrals do not apply to the OneNet PPO Network. Do not use the Referral Submission system online. However, in some states, the injured worker or claimant may be required

to use certain care providers to receive benefits. Please contact the injured worker or claimant’s 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 or claimant may not receive benefits, depending on the state, unless an authorized care provider is used. If an in-network care provider is not available, please contact the adjuster to determine where to refer the injured worker or claimant for authorized care.

Laboratory Services

UnitedHealthcare’s requirement that participating laboratory providers must be used does not apply. The injured worker or claimant may not receive benefits unless an authorized laboratory is used. Please contact the adjuster for guidance. Use your best efforts to refer to a laboratory based on the information provided by the adjuster. The OneNet PPO 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 and auto liability networks do not include a pharmacy network. Contact the adjuster to determine where to refer the patient for care.

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 Network. Please contact the adjuster for the name of a specialty pharmacy provider, as the injured worker or claimant may be required to use certain care providers to receive benefits.