These Specialist Referral Requirements will apply to the following:
- UnitedHealthcare Community Plan for Families (Medicaid)
- UnitedHealthcare Community Plan Wellness 4 Me (HARP)
- UnitedHealthcare Community Plan ChildHealthPlus (CHP)
This new change will take effect on 03/01/2021. The referrals will need to be generated by the member’s PCP. Primary Care Providers can begin to request a referral for any date on 03/01/2021 and thereafter.
Between now and 03/01/2021, in network specialists will continue to get reimbursed as usual.
The following services that WILL NOT REQUIRE A REFERRAL:
- Women´s Health Care
- Family Planning
- HIV and STI Screening
- Eye Care (subject to benefit limits in member handbook)
- Dental Care
- Behavioral Health – (Mental Health and Substance Use)
- Smoking Cessation
- Maternal Depression Screening
- Services rendered in any emergency room or network urgent care center
- Physician services for emergency/unscheduled admissions
- Any services from inpatient consulting physicians
- Radiologist, Pathologist, Anesthesia, etc. Providers that are part of inpatient hospital care or surgical teams do not need referrals
- A specialist who has arranged to act as the member’s PCP does not need a referral for him or herself. Please see FAQs for additional information. Any other services for which applicable laws and regulations do not allow us to impose a referral requirement.
ANY services that are NOT LISTED above will REQUIRE a REFERRAL from the PCP to the IN-Network Specialist.
If you have any questions, please call: 888-362-3368.
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