August 2021 Network Bulletin overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

• Medical policy updates: August 2021
  This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
  
  
• Pharmacy updates
  This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
  
  
• Prior authorization and notification requirement updates
  We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.
  
  
• Reimbursement policy updates: August 2021
  This month, you’ll find updates for Medicaid and commercial plans.
  
  
• Specialty Medical Injectable Drug program updates: August 2021
  See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.

Prior Authorization

• Prior authorization code updates for commercial plans
  Effective Nov. 1, 2021, we are adding new codes to the prior authorization list for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans.
  
  
• Medicaid: New facet injection codes for prior authorization in select states
  AZ, CA, MD, MO, MS, NJ, WI
  Effective Nov. 1, 2021, we’re adding 6 new facet injection procedure-related CPT^® codes (64490‒64495) to the prior authorization list for UnitedHealthcare Community Plan members in certain states.
  
  
• Radiation therapy prior authorization for Oxford Health Plan
  CT, NJ, NY
  Effective Nov. 7, 2021, Optum will manage Oxford Health Plan prior authorization requests for outpatient radiation therapy.
  
  
• Kentucky: Prior authorization and site of service update
  We previously announced an Aug. 1, 2021, implementation date for prior authorization and site of service reviews for commercial plans in Kentucky. Please note, we’re delaying the implementation date to Oct. 1, 2021.
  
  
• New Jersey: Additional codes for early elective delivery prior authorization
  Effective Jan. 1, 2021, more codes for Early elective delivery (EED) are now eligible for reimbursement for services back to Jan. 1, 2021.
  
  
• New Jersey: Medicaid prior authorization requirements for certain therapy services
  Effective Oct. 1, 2021, we’ll require prior authorization for all occupational therapy (OT), physical therapy (PT) and speech therapy (ST) services for UnitedHealthcare Community Plan of New Jersey members.

More state and regional policy and protocol updates

• West Region: Medical PRAs will not be mailed after October
  AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, WA, WY
  Effective Nov. 5, 2021, we will no longer print and mail paper provider remittance advice (PRAs) for medical claims to in-network health care professionals and facilities in the certain states.
  
  
• New states in scope for naviHealth post-acute care
  AR, DE, HI, ID, LA, MS, MO, NE, PA, UT, WV, WY
  Effective Oct. 1, 2021, naviHealth will start managing post-acute care for UnitedHealthcare^® Medicare Advantage members in certain states.
  
  
• Arizona: Electronic payments required for UnitedHealthcare Community Plan
  Beginning July 1 and continuing in waves throughout the month, we will no longer send paper checks for claim payments to Community Plan health care professionals in Arizona. This change is part of our efforts to speed up payments to your practice by moving to digital transactions.
  
  
• Maryland: New outpatient injectable drug requirements
  Effective Nov. 1, 2021, prior authorization will be required for the drugs listed below for UnitedHealthcare Community Plan of Maryland members.

CPT^® is a registered trademark of the American Medical Association. 

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