Posted in Insurance, My services, Training, Updates

UHC Community Health (NY) Specialist Referral Requirements, 03/01/2021

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. 

#UHC #referral #specialists #PCP #NYproviders #communityhealth #HARP #nymedicaid



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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