July monthly overview

Network News is published monthly. See updates below.

July 1 publication

Medical policy updates
Medical policy updates for July 2026 for the following plans: Medicare, Medicaid, Exchanges and commercial.

Reimbursement policy updates
See the latest updates for reimbursement policies.

Specialty Medical Injectable Drug program updates
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.

Pharmacy and clinical updates
Access upcoming new or revised clinical programs and implementation dates for UnitedHealthcare plans.

Arizona Medicaid: Vaccines for Children renewal requirement
Providers enrolled in the Arizona Vaccine for Children program must re-enroll by Aug. 31, 2026.

Massachusetts Medicaid: Coverage change for weight loss and obesity drugs
Beginning July 3, 2026, to comply with MassHealth, we’ll no longer cover weight loss and obesity drugs.

Maryland Medicaid: Plan ahead for the MPRIME provider enrollment transition
Avoid delays during Maryland Medicaid’s move to MPRIME by completing required steps before October.

Maryland Medicaid: Reminder of state medical records audit
Use our tips to ensure your documentation is complete, accurate and aligned with billing to avoid denials or recoupments.

New Mexico Medicaid: Requirement to enroll with state delayed to October
Effective Oct. 1, 2026, rendering, ordering and prescribing providers must enroll with Medicaid to receive reimbursement.

Ohio Medicaid: Change to doula coordination of benefits
Starting July 1, 2026, you need to bill primary insurance before Medicaid for doula services.

Ohio Medicaid: Incontinence and respiratory prior auth requirements
View the prior auth requirements for incontinence and respiratory supplies when a non-preferred vendor is utilized.

Ohio Medicaid: Provider enrollment requirement
Enroll in the Provider Network Management system to help prevent Ohio Medicaid claim issues.

Medicaid: Prior authorization removal for select electrical stimulation codes
Beginning Sept. 1, 2026, we’ll remove prior authorizations for certain electrical stimulation codes in select states.

New genetic and molecular prior auth program requirements
On Oct. 1, 2026, we’ll add new genetic and molecular codes issued by the AMA.

Prior authorization required for radiology services for Surest plans
On Oct. 1, 2026, prior authorizations will be required for radiology services for Surest plans.

View updated national Gold Card code list
As of May 1, 2026, the national Gold Card list has been updated to remove certain codes from prior authorization.

Medicare: New DME process for select members in multiple states
On Sept. 1, 2026, you’ll use Synapse Health for durable medical equipment orders in CT, DC, DE, GA MA, ME, NH, NJ, NY, PA and RI.

New drugs added to UnitedHealthcare Individual Exchange Plan prescription drug list
On July 1, 2026, we’re expanding our prescription drug list for UnitedHealthcare Individual Exchange members.

The Salvation Army – Central Territory members added to Choice Plus network
The Salvation Army – Central Territory members have access to the Choice Plus network on July 1, 2026.

Advance health equity: Hypertension awareness and care
This chronic disease awareness month, learn more about ways to support your patients with hypertension.

Changed naming convention for commercial UCap Capitation Detail Files
We’ve added codes to the Capitation Detail File names so it’s easier for you to know what’s in the report. See the table.

Complete the required special needs plan training by Dec. 31, 2026
CMS requires all special needs plans to complete this 10-minute training by Dec. 31, 2026.