01/16/2026
This is what I received from UHC:
To support the transition and because referral requirements are new on many UnitedHealthcare HMO and HMO-POS plans:
· UnitedHealthcare will not deny claims for lack of referral on plans with new referral requirements for dates of service through April 30, 2026
· However, providers are encouraged to begin submitting referrals for services scheduled on or after Jan. 1, 2026.
· Claims for specialist services without a referral will be denied beginning May 1, 2026.
How to submit a referral: In the coming weeks, we’ll share details about how to submit referrals to Optum for your patients covered by UnitedHealthcare Medicare Advantage HMO and HMO-POS plans.
Planning ahead:
Prepare your patients: Begin discussing the new referral requirements for 2026
Most HMO and HMO-POS plans require referrals for specialist care
Services provided without a referral are the care provider’s responsibility and cannot be billed to the member
Prior authorization and advance notification requirements still apply
Refer to the links below to identify specialties and services that do not require referral