Oxford: PCP and referral requirements

Last modified: May 4, 2021

Starting July 1, 2021, primary care provider (PCP) and referral requirements will be enforced for UnitedHealthcare Oxford plans for members in the Metro, Liberty and Freedom plans.

As groups renew or become effective starting July 1, 2021, we'll start enforcing the PCP and referral requirements for all gated Oxford plans.

PCP and referral requirements

• Members must go to their primary care provider (PCP) on record for a PCP visit for that visit to be covered (no referral required). Otherwise the claim will be denied or the member will pay out of network (OON) if they have that benefit.
• If members need a referral, they must go to their PCP on record to get the referral for approval
• A member must go to the provider they were referred to or the claim will be denied, or the member will pay out of network (OON) if they have that benefit

Submitting referrals

Submit new referral requests and check the status of submissions with referrals.

Questions?

Please reach out to your UnitedHealthcare representative. 

PCA-1-21-00498-E&I-News_03112021