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

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.

Outpatient Procedure Grouper mapping update

Our updated 2021 UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit is available at UHCprovider.com/claims.

FAQ available to support molecular diagnostic testing Z-Code requirement

UnitedHealthcare Medicare Advantage requires providers in a Medicare jurisdiction that has implemented the MolDX program to submit the appropriate DEX Z-Code™ for molecular diagnostic test services.

Genetic prior authorization waiver has expired

The penalty waiver for genetic testing prior authorization requests has expired. Ordering providers must request prior authorization using the Prior Authorization and Notification platform.