New York Medicaid: No referrals needed for specialist visits
AI 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.
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