MedicaidPrior AuthHigh impact
New York Medicaid: No referrals needed for specialist visits
UnitedHealthcare·NY · Allergy & Immunology, Dermatology, Endocrinology +12 more·State news
Effective date
Jan 1, 2026
We identified it
Apr 1, 2026
Summary
Effective January 1, 2026, UnitedHealthcare Community Plan of New York no longer requires referrals for the first follow-up visit with 14 specialist categories within 7 days of emergency room or hospital discharge for Medicaid members. However, referrals are still required for any additional visits beyond the first follow-up.
Action Required
Immediately: Update billing workflows to eliminate referral verification for first follow-up visits within 7 days of discharge for the 14 specified specialist categories (allergy/immunology, dermatology, endocrinology, gastroenterology, general surgery, neurosurgery, orthopedic surgery, ENT, PM&R, plastic surgery, podiatry, pulmonology, sports medicine, urology, vascular surgery). Front desk staff must still verify referrals for subsequent visits after the first follow-up. Update authorization tracking systems to distinguish between first follow-up visits and additional visits.