Starting Nov. 17, 2021, UnitedHealthcare Community Plan of New Jersey is implementing a referral process for members who need specialty care. This will require primary care providers (PCPs) to generate a referral for members to see in-network specialists.
PCPs should start using this referral process for specialist visits beginning on Nov. 17, 2021. This referral process will be implemented for all in-network providers and UnitedHealthcare Community Plan of New Jersey Family Care members, including members who receive managed long-term services and supports (LTSS). At this time, the referral requirement does not apply to UnitedHealthcare Dual Complete® ONE (FIDE SNP) members.
We will not issue specialist claim denials between Nov. 17, 2021, and Jan. 1, 2022, to allow time for you and your staff to generate referrals on behalf of members using the new process. After Jan. 1, 2022, a referral must be in place prior to the specialist visit for the specialist claim to be paid.