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Provider News

Specialist Referral Requirement (Medicare)

We’ve heard your questions regarding the specialist referral requirement, which was effective January 1, 2018, for most Health Partners Medicare members. We’ve updated our list of Frequently Asked Questions (FAQs) on this topic. 

As always, a complete list of Health Partners Medicare participating specialists can be found on our Find a Doctor page.  For a printed list of participating specialists, contact our Member Relations department at 1-866-901-8000 (TTY 711).

This new requirement will include all Health Partners Medicare Special (HMO SNP) members as well as Health Partners Medicare Prime, Health Partners Medicare Value and Health Partners Medicare Basic members who reside in Philadelphia, Bucks, Chester, Delaware and Montgomery counties.

Specialist referrals will not be required for  members enrolled in our Health Partners Medicare Prime and Health Partners Medicare Value plans who live in Lancaster, Lehigh and Northampton counties.

For questions or more information about the Medicare specialist referral requirement, contact our Provider Helpline at 1-888-991-9023 (9 a.m. to 5:30 p.m., Monday-Friday).