Effective March 1st: UnitedHealthcare Community Plan of NY has a new requirement for Primary Care Provider Referral to Specialist

February 23, 2021

Please read the attached FAQ from UnitedHealthcare Community Plan of NY regarding their new referral process for members in need of services from a specialist provider. All in-network providers and UnitedHealthcare Community Plan of NY members for the following product lines are affected:

 

  • UnitedHealthcare Community Plan for Families (Medicaid)
  • UnitedHealthcare Community Plan Wellness 4 Me (HARP)
  • UnitedHealthcare Community Plan ChildHealthPlus (CHP)

 

All specialist visits occurring after March 1, 2021 will require a referral from the patient’s Primary Care Physician (PCP).  The referral must be in place prior to the visit.

 

Important to note: 

 

  • The new policy goes into effect for visits occurring on or after Monday, March 1, 2021.

 

  • If you are a PCP, and are referring a patient to a Specialist, please make sure to follow the process referred to on Page 2 of the FAQ.

 

  • If you are a Specialist, please have your patient contact their PCP to request a referral to you.

 

  • Not all services required a referral- there is a list of services that are exempt from this new process on Page 2 of the FAQ

 

  • Some services have exceptions to the general process. These exceptions are explained on Page 3.

Please refer to the UnitedHealthcare Community Plan FAQ for full details

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