2026 Advanced Primary Care Plan Referral Process
The 2026 Advanced Primary Care Plan requires you to have an Aligned primary care provider and the plan requires a referral anytime you need to see a doctor or get services outside of your regular primary care visits (see Q5 for exceptions) This referral process - called Pave the Way - helps make sure you see a provider that has agreed to work with your plan and your bills will be handled accordingly.
Quick reference
Question
Details
Who gives me a referral?
Your Aligned Marketplace primary care doctor
Who gets the referral?
ClaimDOC — by phone, online portal, fax, or email
ClaimDOC phone number
888-330-7295
ClaimDOC member portal
portal.claim-doc.com
Email (Have your doctor email the referral directly)
pnf@claim-doc.com
What happens next?
Work with a ClaimDOC Member Advocate to ensure the provider you are referred to is approved, or to choose an approved provider/ facility.
No referral needed for:
Kids’ doctor visits (pediatrics), OB/GYN, Mental health.
Contact ClaimDOC directly to choose an approved provider/ facility for these visits.
Contact ClaimDOC directly to choose an approved provider/ facility for these visits.
Member FAQs
What is the Pave the Way referral process?
Pave the Way is the name for how your health plan handles referrals. When your Aligned primary care doctor sends you to see another doctor or get a test done, you’ll need to work with ClaimDOC.
ClaimDOC works with you to make sure your referral is on file and your provider is approved - helping you avoid denied claims and unexpected bills.
ClaimDOC works with you to make sure your referral is on file and your provider is approved - helping you avoid denied claims and unexpected bills.
Why do I need a referral?
The referral lets ClaimDOC know you need care outside of primary care. ClaimDOC will then help confirm whether the referred provider participates with the plan or assist you in finding a doctor or facility that works with your health plan, helping keep your out‑of‑pocket costs as low as possible.
Do I need to pick a primary care doctor?
Yes — and your primary care doctor needs to be part of the Aligned. If you haven’t picked one yet, you’ll need to do that first before you can get a referral. Choose your primary care doctor by visiting: https://app.alignedmarketplace.com
What kinds of appointments or services need a referral?
You need a referral any time you’re going somewhere other than your Aligned primary care doctor, including:
• Seeing a specialist (like a heart doctor, skin doctor, bone doctor, etc.)
• Getting imaging done (X-rays, MRIs, CT scans, ultrasounds)
• Lab work or blood tests outside your primary care office
• Physical therapy, occupational therapy, or similar services
• Any procedure done at a hospital or outpatient facility
If you’re not sure whether something needs a referral, contact ClaimDOC.
• Seeing a specialist (like a heart doctor, skin doctor, bone doctor, etc.)
• Getting imaging done (X-rays, MRIs, CT scans, ultrasounds)
• Lab work or blood tests outside your primary care office
• Physical therapy, occupational therapy, or similar services
• Any procedure done at a hospital or outpatient facility
If you’re not sure whether something needs a referral, contact ClaimDOC.
Are there any appointments that do NOT need a referral?
Yes! You can work directly with ClaimDOC to find an approved doctor for the following visits without needing to get a referral from your primary care doctor first:
• Kids’ doctor visits (pediatrics)
• OB/GYN visits
• Mental health appointments
• Kids’ doctor visits (pediatrics)
• OB/GYN visits
• Mental health appointments
How do I get a referral?
Talk to your Aligned primary care doctor. Let them know what you need — whether it’s seeing a specialist, getting a test, or anything else. Provide them with the ClaimDOC referral form or ask them to send a referral directly via email.
• Ask your doctor to fill out THIS FORM
• Ask your doctor to send it directly to ClaimDOC by emailing pnf@claim-doc.com or faxing 844-605-7636
• If your doctor sends it directly to ClaimDOC, you’re all set — no extra steps needed on your end.
• If your doctor cannot send the form, you may submit the form via the ClaimDOC portal portal.claim-doc.com or by calling 888-330-7295
Once you submit your referral, you'll be connected with a ClaimDOC member advocate for next steps to ensure the provider you are referred to works with the plan and submits claims.
• Ask your doctor to fill out THIS FORM
• Ask your doctor to send it directly to ClaimDOC by emailing pnf@claim-doc.com or faxing 844-605-7636
• If your doctor sends it directly to ClaimDOC, you’re all set — no extra steps needed on your end.
• If your doctor cannot send the form, you may submit the form via the ClaimDOC portal portal.claim-doc.com or by calling 888-330-7295
Once you submit your referral, you'll be connected with a ClaimDOC member advocate for next steps to ensure the provider you are referred to works with the plan and submits claims.
What information needs to be in the referral?
Your doctor doesn’t need to use the specific form — but ClaimDOC does need all of the following details to process your referral:
About you:
• The name of the person who holds the insurance plan
• Your insurance ID number (on your insurance card)
• Your name
• Your date of birth
• Your contact information
About your Aligned doctor:
• Your primary care doctor’s name
• The date they’re sending the referral
About where you’re being sent:
• The name or type of doctor or facility you’re being referred to
• Their location
• The reason for the visit (your doctor will have a diagnosis code for this)
• What services you’re getting
• How many visits are expected
• Approximate start and end dates
• Any other notes
About you:
• The name of the person who holds the insurance plan
• Your insurance ID number (on your insurance card)
• Your name
• Your date of birth
• Your contact information
About your Aligned doctor:
• Your primary care doctor’s name
• The date they’re sending the referral
About where you’re being sent:
• The name or type of doctor or facility you’re being referred to
• Their location
• The reason for the visit (your doctor will have a diagnosis code for this)
• What services you’re getting
• How many visits are expected
• Approximate start and end dates
• Any other notes
How do I send my referral to ClaimDOC?
If your doctor gave the referral to you, you can get it to ClaimDOC in two ways:
Option 1 — Online through the ClaimDOC portal:
• Go to portal.claim-doc.com
• Log in to your account
• Enter your referral details
Option 2 — Call ClaimDOC:
• Call 888-330-7295
• Have your referral information handy and they’ll walk you through it
You don’t need to upload or mail any paperwork — just have the information ready.
Option 1 — Online through the ClaimDOC portal:
• Go to portal.claim-doc.com
• Log in to your account
• Enter your referral details
Option 2 — Call ClaimDOC:
• Call 888-330-7295
• Have your referral information handy and they’ll walk you through it
You don’t need to upload or mail any paperwork — just have the information ready.
Can my doctor send the referral straight to ClaimDOC?
Yes, and that’s totally fine! Your doctor can email the referral directly to ClaimDOC via email at pnf@claim-doc.com or fax 844-605-7636. If they do that, you don’t need to do anything else.
Do I need to send the actual form?
No. There’s no specific form required. What matters is that ClaimDOC gets all the information listed above — however it gets to them (online, by phone, or emailed by your doctor) is fine.
What happens after ClaimDOC gets my referral?
Once ClaimDOC has your referral on file, they will connect you with a Member Advocate to help you choose an approved provider.
Can I go ahead and schedule a visit with a doctor after I send my referral in?
Yes, you may schedule an appointment. However, you must submit your referral to ClaimDOC and receive an approval before your appointment. If not, your claim may be denied or you may receive an unexpected bill.
What if I have questions or need help?
ClaimDOC’s team is easy to reach:
• Call: 888-330-7295
• Online: portal.claim-doc.com
• Email: membersupport@claim-doc.com
Give them a call if you’re unsure whether you need a referral, need help sending one in, or just have questions about how your plan works.
• Call: 888-330-7295
• Online: portal.claim-doc.com
• Email: membersupport@claim-doc.com
Give them a call if you’re unsure whether you need a referral, need help sending one in, or just have questions about how your plan works.