Maryland: Reminder to submit referrals with IFP claims

Claims denied for missing referrals may require an appeal

This is a reminder that all evaluation and management (E&M) and specialty service claims submitted to UnitedHealthcare for Individual and Family plan members require an accompanying referral from a primary care provider. The referral must be included in the claim submission. Any paper or electronic claims submitted without the required referral will be denied. 

Electronic claims – online guidance

Starting in December 2025, when you submit a claim using electronic data interchange (EDI) or the UnitedHealthcare Provider Portal, within 24 hours you’ll receive the Smart Edit mnemonic uATCMDREF if an accompanying referral is not included with the submission. You’ll also receive a notice on your clearinghouse rejection (277CA) report. This automated Smart Edits preview allows you to avoid claim denials if it’s corrected in a timely manner.

You can correct the claim by submitting a referral within 5 calendar days of claim submission before it enters our system. If you’ve missed the 5-calendar day window for the Return Edit and we’ve denied the claim, you’ll need to submit an appeal.

Paper claims

If you submit claims by mail, you will not receive a Smart Edits notification if an accompanying referral is not included in the submission. Your claim will be denied if the referral is missing.

How to resubmit a denied claim in Maryland

In the state of Maryland, providers cannot submit a claim for reconsideration once it’s denied. Providers in Maryland would need to appeal the denial. For more information, please refer to the Claim reconsideration and appeals process section of the 2025 UnitedHealthcare Care Provider Administrative Guide for Commercial, Individual Exchange and Medicare Advantage.