MedicaidPrior AuthMedium 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
Jun 13, 2026
Summary
Starting January 1, 2026, UnitedHealthcare Community Plan of New York no longer requires referrals for the first follow-up visit with 15 specialist categories within 7 days of a member's discharge from the emergency room or hospital. Referrals are still required for any additional visits beyond the first follow-up visit.
Action Required
Immediately: Update billing workflows to remove referral requirements for first follow-up visits within 7 days of hospital/ER discharge for the 15 specified specialist categories (allergy, dermatology, endocrinology, gastroenterology, general surgery, neurosurgery, orthopedic surgery, ENT, PM&R, plastic surgery, podiatry, pulmonology, sports medicine, urology, vascular surgery). Train front desk staff to verify discharge date and visit count. Continue requiring referrals for second and subsequent visits.