More to Know About Referral Requirements
Posted by PHN Communications | Feb 18, 2026 | Featured News
Ensure Smooth Patient Access to Specialist Care
Update
Last modified: April 16, 2026
Peoples Health HMO plans require referrals for specialty services, supporting a primary care-led model focused on coordinated, high-quality care. We’ve seen strong adoption of these requirements and appreciate the continued partnership of our primary care network.
As we refine our processes, we'll continue to defer adverse payment decisions related to referral requirements, extending the current grace period previously set to end April 30, 2026. We’ll share additional details as updates are implemented, including advance notice before the grace period ends.
Providers should continue submitting referrals for services scheduled on or after Jan. 1, 2026.
As a reminder, all Peoples Health plans, except Peoples Health Choices (PPO) and Peoples Health Patriot (PPO), require a referral from a primary care provider (PCP) for certain specialist care.
Not all specialist visits require a referral.
Frequently Asked Questions
How are referrals submitted?
PCPs must submit referrals electronically via the UnitedHealthcare Provider Portal, an Application Programming Interface or Electronic Data Interchange. Referrals may not be submitted by fax, email or paper.
Can a specialist enter a referral?
Referrals must be entered by a network PCP. This could be the patient’s assigned PCP or another PCP under the same tax ID number (TIN) or in the network.
Can I designate a referral for an entire clinic or practice?
No. PCPs must select a specific specialist when entering the referral. The referral will match if the specialist on the claim is the named provider or another provider under the same TIN and of the same specialty.
Do referrals take the place of prior authorization?
No. Prior authorization and advance notification requirements still apply.
Questions? Contact Michele Fontenot at michele.fontenot@peopleshealth.com or Djuana Larrieu at djuana.larrieu@peopleshealth.com.
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