UNITEDHEALTHCARE SYSTEM NOTIFICATION
Re: Referral Required Message to Display on Eligibility and Benefit EDI Response (271) Transactions
UnitedHealthcare is adding an Electronic Data Interchange (EDI) referral indicator to eligibility response (271) transactions as of Mar. 1, 2017, for all lines of business.* If the member is enrolled in a plan requiring a referral from their Primary Care Physician (PCP) before seeing a network specialist, the following message should appear notifying the care provider: PCP to submit a specialist referral. Referrals should be requested electronically as a 278 EDI transaction.
The following steps outline the changes UnitedHealthcare is making to the 271 transaction (005010X279A1):
1. EB11 Authorization or Certification Indicator in the 2110c and 2110d loop include the Y value to indicate preauthorization/notification/referral is required at the plan level.
2. For the 2110c and 2110d, MSG segment, include the referral reminder message: “PCP to submit a specialist referral.”
Contact UnitedHealthcare EDI Support at 800-842-1109 if you have any questions. Please forward this communication to your customers as needed.