More to Know About Referral Requirements
Posted by PHN Communications | Feb 18, 2026 | Featured News
Ensure Smooth Patient Access to Specialist Care
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.
However, please note: Claims will not deny for lack of referral for dates of service through April 30, 2026. We do encourage providers to begin submitting referrals now for applicable services to ensure their Peoples Health patients receive uninterrupted care and to avoid claim denials for missing referrals for dates of service on or after May 1, 2026.
- For dates of service through April 30, specialists may see Peoples Health patients without a referral on file with no impact on claims processing.
- On and after May 1, referrals must be in place for applicable specialist services, and the specialist must ensure a referral is on file.
- Services provided without a referral are the care provider’s responsibility and cannot be billed to the patient.
Not all specialist visits require a referral. See a list of excluded specialist types here, as well as a list of services that don’t require 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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