MedicaidAdministrativeMedium impact
Reminder: No Referrals for EmblemHealth’s NYS Sponsored Plans in 2023
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Starting January 1, 2023, EmblemHealth eliminated PCP referral requirements for specialty care visits for their New York State Medicaid, HARP, and Child Health Plus members. This means billing teams can process specialty visits for these plans without requiring referral documentation.
Action Required
Immediately: Update billing system to remove referral requirements for EmblemHealth Medicaid (Enhanced Care), HARP (Enhanced Care Plus), and CHPlus members in New York. Train front desk staff to stop requesting referrals for these plan types. Update encounter forms and scheduling protocols to reflect no referral needed for specialty visits.