Referral to a Preferred Specialist is Done with Ease
No referrals or authorizations are needed for PCP-to-Preferred Specialist referrals, nor for Preferred Specialist-to-Preferred Specialist referrals. Your patients can see any Preferred Specialist for as many visits are required to keep your patients stable and in good health.
Referral Process Tool
Use our Referral Process Tool to determine if a referral is required for the specialist you have chosen with your patient.
- You will need to know if the provider is an HCP Preferred Specialist and your patient’s medical coverage.
- Start by determining the Provider’s status below.
I am a PCP
I am a specialist in the HCP Preferred Specialist
I am NOT an HCP Preferred Specialist


The patient is covered by EmblemHealth.
- Refer to an HCP Preferred Specialist — No Referral Required
- Refer to a NON-Preferred Specialist — Prior Authorization Required
The patient is covered by Humana, Aetna®, Elderplan, Fidelis Care (Medicaid), Anthem, Centers Plan for Healthy Living, UnitedHealthcare, or VillageCareMAX.
- Referral activity not managed by HCP


Providing Care to a HealthCare Partners, IPA patient / Referring to another HCP Preferred Specialist
- The patient is covered by EmblemHealth — No Referral Required
- The patient is covered by Humana, Aetna®, Elderplan, Fidelis Care (Medicaid), Anthem, Centers Plan for Healthy Living, UnitedHealthcare, or VillageCareMAX. — Referral activity not managed by HCP
Referring to a NON-Preferred Specialist
- Prior Authorization Required


Providing Care to a HealthCare Partners, IPA patient
- Prior Authorization Required
Referring to another Specialist
- The patient is covered by EmblemHealth
- Referring to an HCP Preferred Specialist — No Referral Required
- Referring to a NON-Preferred Specialist — Prior Authorization Required
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- Refer to an HCP Preferred Specialist — Notification Required
- Refer to a NON-Preferred Specialist — Prior Authorization Required
- The patient is covered by Humana, Aetna®, Elderplan, Fidelis Care (Medicaid), Anthem, Centers Plan for Healthy Living, UnitedHealthcare, or VillageCareMAX.
- Referral activity not managed by HCP