ExchangeAdministrativeHigh impact
Maryland: Reminder to submit referrals with IFP claims
UnitedHealthcare·MD·Network News
Effective date
Dec 1, 2025
We identified it
Jun 13, 2026
Summary
UnitedHealthcare requires all evaluation and management (E&M) and specialty service claims for Individual and Family Plan (IFP) members in Maryland to include a referral from a primary care provider with claim submission. Electronic claims will receive Smart Edit warnings starting December 2025, but paper claims will be denied immediately if referrals are missing.
Action Required
Immediately: Billing team must ensure all E&M and specialty service claims for UnitedHealthcare Individual and Family Plan members in Maryland include primary care provider referrals with submission. Update billing workflows to verify referrals before claim submission. For electronic claims, monitor for Smart Edit mnemonic uATCMDREF notifications and submit missing referrals within 5 calendar days to avoid denials. Claims denied for missing referrals require appeals, not resubmissions.