Avoid claim denials – make your PNM updates before Oct. 20, 2023
Effective Oct. 20, 2023, Next Generation Medicaid managed care organizations (MCOs), the OhioRISE plan and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as the official system of record. Health care professionals must keep their records updated within the PNM module. If your data in the PNM module does not match the data on your submitted claims, your claims will be denied for payment.
View the current UnitedHealthcare Community Plan Reimbursement Policies.
We have compiled a list of evidence-based clinical guidelines and where they can be found for our quality and health management programs.
We respect the expertise of the physicians and other health care professionals in our network and appreciate your help as we work together to offer our members better quality, better health outcomes and better cost.
If you have questions, please contact your Physician Advocate or call the number on the back of the member’s ID card.
UnitedHealthcare has developed medical policies, medical benefit drug policies, coverage determination guidelines, and utilization review guidelines to assist us in administering health benefits. These policies and guidelines are provided for informational purposes and do not constitute medical advice.
For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries and corresponding Policy Update Bulletins.