Maryland: Reminder to submit referrals with IFP claims
AI Summary
UnitedHealthcare Maryland requires all evaluation and management (E&M) and specialty service claims for Individual and Family Plan (IFP) members to include referrals from primary care providers with claim submission. Starting December 2025, electronic claims will receive Smart Edit notifications within 24 hours if referrals are missing, allowing 5 calendar days to correct before denial.
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 referrals with submission. Update billing workflows to check for referrals before claim submission. For electronic claims, monitor for Smart Edit mnemonic uATCMDREF and clearinghouse rejection reports, then submit missing referrals within 5 calendar days to avoid denials. Claims denied for missing referrals require appeals, not resubmissions.
Plan Types
Exchange
States
MD
Specialties
all-specialties