New York Medicaid: No referrals needed for specialist visits
AI Summary
Starting January 1, 2026, UnitedHealthcare Community Plan of New York (Medicaid) no longer requires referrals for the first follow-up visit with 14 specialist categories within 7 days of emergency room or hospital discharge. However, referrals are still required for any additional visits beyond that first follow-up appointment.
Action Required
Immediately: Update billing workflows and staff training for New York Medicaid patients. Front desk staff must verify if specialist visits are follow-ups within 7 days of discharge (no referral needed) or subsequent visits (referral required). Billing team should flag claims for the 14 listed specialties to ensure proper referral documentation exists for visits beyond the initial follow-up.
Plan Types
Medicaid
States
NY
Specialties
allergy-immunology, dermatology, endocrinology, gastroenterology, general-surgery, neurosurgery, ortho, ent, pm-r, plastic-surgery, podiatry, pulmonology, sports-medicine, urology, vascular-surgery