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Questions Healthcare Providers Ask Us

Why is Oxford requiring all referrals to be submitted electronically?

Beginning November 1, 2000, Oxford will require all participating physicians and providers to submit all referrals electronically. At Oxford, we are committed to giving you tools that allow you to reduce the time you spend on administration and focus your efforts on practicing medicine. Electronic referrals save time, improve turnaround times, and eliminate paper trails.

Does this change Oxford’s referral policy?

Oxford’s referral policy will not change as a result of this new electronic referral requirement. Participating primary care physicians, OB/GYNs, and select specialists may generate referrals. As always, referrals to non-participating providers require precertification.

How do we submit electronic referrals to Oxford? (could we have the www. actually link into that application?)

You can submit electronic referrals to Oxford using:
Oxford’s web site at www.oxfordhealth.com.
Oxford’s automated phone system, Oxford Express® (800-666-1353).
Envoy point-of-service terminal or Envoy’s software solution, Enline Companion.

What does an electronic referral cover?

A submitted referral is valid for all covered services performed by the referred-to provider that do not require precertification. For services that do require precertification, the provider must call 800-666-1353.

When “covering” PCPs need to refer Members, do they use the covering PCP’s provider ID, or the provider ID of a Member’s actual PCP?

If “covering” PCPs need to generate an electronic referral for Members, they would use their own ID as the referring provider.

Which specialists can submit referrals?

OB/GYNs, orthopedists, and neurologists can refer Oxford Members for services related to their specialty only.

Can any other specialists submit referrals?

Specialists who need to send a Member for further testing (diagnostic, radiology, etc.) and cannot perform the services in their office may generate a new electronic referral for that Member.

What should we do if a Member comes to our office with a paper referral?

Still service the Member as appropriate. However, if you notice that a referring provider or PCP you work with continues to use paper referrals on a regular basis, please feel free to contact the EDI Support Line so that we may educate that office.

What is EDI, and where can I get more information about EDI?

EDI (Electronic Data Interchange) is an advanced form of electronic business-to-business communication that instantly links your computer system with Oxford’s computer system, as well as with other health plans and government payers. We have a team of EDI experts ready to help you. Please call 800-599-4EDI.

How do I get additional information about a Member's benefits?
Providers have access to two different sources where this information can be obtained. The first option is to call the Provider Service phone number and discuss the benefits with a Provider Service Associate. The second option is to use the
Check Benefits link on this web site, which allows providers to review a Member's benefits.

Why do I get an error when I try to view claims by date range?
The most common cause of this problem is that the date range selected is too large. Try narrowing the date range, then try the claim inquiry again with the smaller date range.

How do I inform Oxford of a change in my billing address or other information?

It is important that we have an accurate provider profile in our database. Your correct practice address and telephone numbers are needed to list you correctly in the roster and to receive important mailings. An accurate billing address is necessary, as it directly influences claims logging and payment.

When submitting an address, telephone, or tax ID change, it is imperative to include the following:
When submitting a request on provider letterhead, please include the following:
  • Old and new billing address
  • Old and new practice address
  • Phone number changes
  • Current federal tax ID number and Oxford Provider ID number
  • Effective date of change
  • Brief description of the change (new or additional address, telephone number, or tax ID number)
The request can be sent by mail or fax to:

    Vendor Audit
    Oxford Health Plans
    7120 Main Street (Route 25)
    Trumbull, CT 06611

    Fax: 203-601-6671

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