Referral Quick Guide

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“Do I Need a Referral?” - A Quick Guide

Group of healthcare workers talking in hospital.

A few quick ways to identify if your EmblemHealth member needs a referral

EmblemHealth offers a wide range of health plans. For many EmblemHealth members, referrals are not needed from their PCP before receiving care from a specialist.  Still, we know that figuring out which plans require a referral may be confusing.  Watch the two-minute video below that shows your practice how to find out if a member’s plan requires a referral.

Update: Effective December 1, 2020, SOMOS-managed members do not need referrals to see specialists.
Retroactive to Dec. 1, 2020, the referral requirement for SOMOS-managed members has been eliminated for participating EmblemHealth providers. Specialists’ claims with dates of service on or after Dec. 1 will not deny for a missing referral.

How do I find which plans need referrals?

Use Provider Portal for Referral Transactions

Once you determine a referral is needed, use our Provider Portal to enter the Referral or to look up one sent to you. See how the Referral transactions work by reviewing the videos and guides under Referrals at the bottom of the Provider Portal Training Materials page.
TIP: To create a Referral, you must search for and enter the Referring Provider as well as the Servicing Provider.

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