Medical policy updates: June 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements and are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: June 2021
This month, you’ll find updates for Medicaid and commercial plans.
Medicaid anti-emetic prior authorization update
AZ, KY, TN
Effective Aug. 1, 2021, prior authorization is required for 8 anti-emetics codes for members with a cancer diagnosis. (Prior authorization requirements for outpatient injectable chemotherapy are not affected by this addition.)
Oncology specialty pharmacy requirement delay
The sourcing requirement for outpatient hospitals to obtain certain oncology supportive care medications for our commercial plan members will go into effect on June 18, 2021, not June 7, 2021 as previously announced in March and April 2021.
This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
Specialty Medical Injectable Drug program updates: May 2021
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.
Electronic payments required soon for UnitedHealthcare Community Plans
CA, OK, NE, PA, TN, TX
We’re no longer sending paper checks for health care professional payment, where not prohibited by law. Instead, you’ll have 2 options for receiving payment from UnitedHealthcare; Automated Clearing House (ACH) /direct deposit online or Virtual card payment through Document Vault or mail.
New states in scope for naviHealth post-acute care
AL, MA, MS, NH, RI, TN, VT
Beginning Aug. 1, 2021, naviHealth will start managing post-acute care for UnitedHealthcare® Medicare Advantage members in Alabama, Maine, Massachusetts, New Hampshire, Rhode Island, Tennessee and Vermont. This is in addition to the post-acute care management change that went into effect for certain states on April 1 and June 1, 2021.
New prior authorization codes for some UnitedHealthcare Community Plan members
FL, HI, MS, NJ, OH, PA, TN
We are adding new codes to the prior authorization list for UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in Hawaii, Florida, Mississippi, New Jersey, Ohio, Pennsylvania and Tennessee.