Medicare Advantage referrals: No immediate claim denials
AI Summary
UnitedHealthcare is extending the grace period for Medicare Advantage HMO referral requirements, continuing to defer claim denials for missing referrals beyond the original April 30, 2026 end date. PCPs must still submit referrals for specialty services starting January 1, 2026, but claims won't be denied during this extended grace period.
Action Required
Continue submitting referrals for Medicare Advantage HMO/HMO-POS specialty services scheduled on or after January 1, 2026. Monitor for future communications from UnitedHealthcare regarding when the grace period will end and claim denials for missing referrals will begin. Note that services from PCPs, mental health providers, OB/GYN, oncologists, emergency medicine, and many others are exempt from referral requirements.
Plan Types
Medicare Advantage
Specialties
family-medicine, internal-medicine, general-practice, pediatrics