Welcome to Network News

Important news updates for health care professionals

The latest updates

Policy and protocol

See policy and protocol updates (formerly Network Bulletin) for Medicare, Medicaid, commercial and individual Exchange plans

Pharmacy and drugs

See updates to preferred drug lists, specialty medical injectable updates, specialty pharmacy lists and more for our plans

Reimbursement policy

Review the monthly update bulletins for Medicare, Medicaid, commercial and individual Exchange plans

Laboratory

See what’s changing with protocols, test registrations, prior authorization, and information relevant to laboratories and referring practitioners

Medical policy

Check the monthly updates bulletins for the latest changes for Medicaid, Medicare, commercial and individual Exchange plans

Prior authorization

View prior authorization updates and use the filters to focus on the plans, states, and some specialties that interest you

 

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Recent News

Use required 340B modifiers for accurate payment

CMS and UnitedHealthcare require a JG modifier on Medicare claims for separately payable, OPPS 340B drugs and biologics (status indicator K) to receive claims payment of ASP minus 22.5%.

New coverage determinations for Vitamin D testing

For claims processed on or after March 1, 2022, vitamin D screening CPT codes 82306, 82652 or 0038U will only be covered for UnitedHealthcare commercial members diagnosed with one of the listed diagnosis codes in the medical policy.

03/2021: 2nd quarter prescription drug list

Commercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021 are now available to view.

Notice of change to review process related to cardiovascular codes that require prior authorization codes

Beginning April 1, 2022, the entire claim will be denied if outpatient cardiovascular prior authorizations are not received or denied due to lack of medical necessity for Medicare Advantage plans.

How to Become a Designated Diagnostic Provider for Imaging

UnitedHealthcare has created the Designated Diagnostic Provider Imaging – a tiered benefit design – to help members receive higher-quality, more affordable imaging services.