Starting March 1, 2021, UnitedHealthcare Community Plan of New York is implementing a referral process for members who need specialty care. This referral process is implemented for the following product lines:
- UnitedHealthcare Community Plan for Familфies (Medicaid)
- UnitedHealthcare Community Plan Wellness 4 Me (HARP)
- UnitedHealthcare Community Plan ChildHealthPlus (CHP)
You can begin to use this referral process for specialist visits occurring on or after March 1, 2021. This
will require you PCPs to generate a referral for members to see in-network specialists.
Services that do not require a referral from a member’s PCP include the following:
- 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.
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.
Source: https://www.uhcprovider.com/en/resource-library/news/2020-network-bulletin-featured-
articles/1220-ny-new-referral-comm-plan.html
https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/bulletins-and-
newsletters/NY-Faqs-New-Requirement-PCP-Referral-Specialists-New-York.pdf
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