This referral requirement has been updated – please see the March 2021 notification.
Starting March 1, 2021, UnitedHealthcare Community Plan of New York is implementing a referral process for members who need specialty care. This referral process will be implemented for the following product lines:
You can begin to use this referral process for specialist visits occurring on or after March 1, 2021. This will require you, the primary care provider (PCP), to generate a referral for members to see in-network specialists.
Between now and the March 1, 2021 effective date, claims for specialists will continue to be paid as usual. Services that do not require a referral from a member’s PCP include the following:
Specialist visits not listed above, occurring after March 1, 2021, will require a PCP referral.
The referral must be in place prior to the specialist visit for the specialist claims to be paid. You may begin to write referrals immediately if you anticipate the date of service will be March 1, 2021, or later.
The new requirement aims to strengthen PCP engagement with our Medicaid members while helping direct members to the appropriate specialty care. The change is expected to help improve health outcomes for members and improve collaboration and coordination of care between members’ respective PCP and specialty providers.
For more information, review our frequently asked questions.
Questions? Call your Network Representative directly or Provider Services for UnitedHealthcare Community Plan at 888-362-3368.