Provider Referrals
UnitedHealthcare Provider Portal tools
Referrals
Use the tool for these plans: commercial, community, Individual Exchange Benefit marketed as Individual and Family Plans, Medicare and Oxford (for members with a numeric group number).
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.
Resources
Frequently searched
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.